ASU Child Development Center

10A NCAC 09 .0601 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0605 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .3222 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0605 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0803 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/1/2026 Number Present: 88 Completed Date: 7/1/2026 Age: From 0 To 5 Total Minutes: 360 Time In: 11:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Dawn McCrary, Child Care Consultant accompanied me today. A signed copy of the visit summary was left on-site with you. Today, Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 6/30/2026. The facility is owned by Appalachian State University. Permit type – Five Star Rated License, issued 3/13/2026 Special Services/Restrictions – first shift, children in care on ground level, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/10/2025. The last fire drill was practiced on 6/24/2026. The last lockdown drill was practiced on 6/5/2026. The last playground inspection was documented on 6/16/2026. The last fire inspection was approved on 7/7/2025. Schedule for tomorrow (7/2/2026) The last sanitation inspection was conducted on 2/11/2026 with nine (9) demerits for a superior classification. The Emergency Medical Care plan was posted and current. EPR plan is current and up to dated 7/1/2026. The approved curriculum Creative Curriculum. Approved formative assessment TS Gold. Lead water testing was completed on 7/6/2024. Lead paint testing completed 4/30/2026. Asbestos testing was completed on 1/17/2025. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Dahlia) group of infant to two-year-old children were engaged in nap time. One (1) staff member was rocking a child, four (4) children in cribs, and two (2) children on cots. While monitoring the classroom, three (3) bottles not labeled and one food item not labeled with the child’s name and date. We discussed reviewing with staff to ensure each bottle and food item is labeled with the child’s name and date. One (1) diaper cream was missing the specific dosage to apply when needed. Space 2 (Raven) group of infant to one year old children were engaged in lunch, one (1) staff member was bottle feeding a child, and one (1) child was asleep. While monitoring the classroom, I observed one (1) diaper cream missing authorization dates, two (2) sunscreens missing the specific dosage amount to apply to the skin prior to going outside, and one (1) diaper cream missing the specific amount to administer. We discussed that a specific amount needs to be added to the form for staff to know how much the parent/guardian wants to have administered. Burn cooling gel was located in the first aid kit. The burn gel was removed during the visit. Space 3 (Willow) group of three- to five-year-old children were engaged in finishing up lunch, routine diaper changes, routine restroom, washing hands, and transitioning to cots for nap. While monitoring the classroom, I observed cots in the block center were less than eighteen (18) inches apart with out a solid barrier between the cots. We discussed that move the cots to allow for more spacing or add a solid barrier between the cots. Twelve (12) different sunscreens were missing the following information: missing dosage, missing specific sunscreen name, when to apply the sunscreen, expiration date, and date the parent signed missing. We discussed reviewing medication forms to ensure all items are completed with the specific information to clearly identified the medication and its usage. Hazardous items were located in the first aid kit in the emergency bookbag (alcohol pads, instant cold pack, antibiotic ointment). We discussed to go through any new first aid kits to remove hazardous products. We only administer soap, water, and a band aid. One (1) emergency inhaler missing the dates to administer the medication. Also the medication form is completed for Proventil instead of Ventolin. We discussed reviewing the medication forms to ensure all the required information is completed accurately. Space 4 A/B (Juniper) group of infants- to one-year-old children were engaged in eating lunch and two (2) were being held by a caregiver. While monitoring the classroom, I observed one (1) sunscreen missing a specific dose. We discussed having parents review and adding the specific dose to apply to the child. Consultation was provided for the Cedar mop in the storage area to store the solution container up five feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. Space 5 (Pine) currently closed and used as storage/staff space. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in nap time. The staff used natural lighting and calming music to assist the children with resting. Staff were actively supervising the children. Space 7 (Hummingbird) group of three- to five-year-old children were engaged in nap time. Two (2) children had completed their nap and were in the gross motor room with another staff member. The staff member in the classroom was actively supervising the children. While monitoring the classroom, I observed one (1) emergency inhaler on-site without a permission to administer medication form. The staff member stated that it was a new medication and thought all the required forms were completed. The staff moved the medication to a locked closet until the medication can be returned to the parent or the form can be completed by the parent at pickup. One (1) child was observed with a blanket over their face. We discussed that during nap the children’s face must be visible to access their well-being. The staff member moved the blanket off the child’s face during the visit. One (1) child was observed wearing an eye mask during the visit. We discussed that the child must remove the eye mask as that is a choking hazard should the mask move during nap. The staff had the child removed the eye mask during the visit. Five (5) medications were missing the following items: specific name, and specific amount/dosage. Space 8 (Chickadee), the group of two to three-year-old children were engaged in nap time. The staff used natural lighting and calming music. Staff assisted children with calming down to rest by rubbing their backs. While monitoring the classroom, I observed two (2) sunscreens missing the specific dosage/amount to administer. Space 9 (Magnolia) group of two- to three-year-old children were engaged in nap time. Staff were actively supervising the children. The staff used natural lighting and calming music to assist the children with resting. While monitoring the classroom, I observed five (5) sunscreens missing the following items: specific amount/dosage, and specific medication name. Consultation was provided to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. Space 10 (Sunflower) group of two- to three-year-old children were engaged in naptime. The staff used natural lighting and calming music to assist the children with napping. Staff actively supervised the children. While monitoring the classroom, I observed three (3) medications missing the specific amount/dosage to apply. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken, pasta, tomatoes, spinach, bread, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated the child just turned two (2) last week in the Dahlia classroom and was on vacation this week. When the child returns they will be moved up to their new classroom. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Ms. Stegall dated that the mulch was tilled 6/25/2026 and significant rain yesterday. Metal man hole cover was hot to touch accessible to children. We discussed covering the man hole with a mat or surfacing. The staff member placed a outdoor rug over the cover during the visit. Keep an eye on the gate post between the preschool and toddler playground as it is being to show signs of wear as paint is beginning to chip. Tarp on the toddler playground was torn and creating potential choking hazard. We discussed to remove and replace the tarp. The program does not provide transportation. Staff and children’s files were monitored during today’s visit. Seven (7) new staff and 3 existing staff files. Concerns: one (1) missing application. Consultation was provided for the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. Eleven (11) children’s files monitored met requirements. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. 15A NCAC 18A .2804(d) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Cots in the block area of space Willow were not 18" apart or separated by partitions. 15A NCAC 18A .2821(e) 713 Children were allowed to play on outdoor equipment that is too hot to touch. On the preschool playgound the metal cover in front of the gate is too hot for children to touch. 10A NCAC 09 .0605(e) 716 All stationary equipment, more than 18 inches high, was not installed over protective surfacing. On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. .0605(j) 721 All equipment and furnishings were not in good repair. The toddler playgound's sandbox tarp cover is ripped and torn in several places. G.S. 110-91(6); .0601(b) 807 A safe indoor and outdoor environment was not provided for the children. In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. 10A NCAC 09 .0601(a) 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. First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. One (1) emergency medication did not have a parent's authorization form in space Hummingbird. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Thirty-five (35) medication authorizations were not completed in their entirety. One (1) emergency medication did not have the dates to be administered. 10A NCAC 09 .0803(4)(6-9) 1030 Application for employment and date of birth was not on file for all staff. One (1) staff, P.W. did not have an application for employment on file. .0302(d)(1)(A) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. G.S. 110-90.2 & .2703(r) Technical assistance was provided as follows: Item 533- Three (3) bottles and one (1) food container were not labeled with the date in space Dahlia. Rule reference: 15A NCAC 18A .2804(d) Item 614- Cots in the block area of space Willow were not 18" apart or separated by partitions. Rule Reference: 15A NCAC 18A .2821(e) Item 713- On the preschool playground the metal cover in front of the gate is too hot for children to touch. Rule Reference: 10A NCAC 09.0605(e) Item 716- On the large playground, surfacing under the rock climbing equipment was compacted and the footings were exposed. Rule Reference: 10A NCAC 09.0605(j) Item 721- The toddler playground's sandbox tarp cover is ripped and torn in several places. Rule Reference: GS 110-91(6) Item 807- In the space Hummingbird, one (1) child had a face mask on at rest time and one (1) child had their head covered with a blanket. Rule Reference: 10A NCAC 09.00601(a) Item 840- First aid kits in Raven and Willow had potentially hazardous materials which were stored unlocked. Rule Reference: .2820(b) Item 842- One (1) emergency medication did not have a parent's authorization form in space Hummingbird. Rule Reference: 10A NCAC 09.0803(1)(a&b) Item 847- One (1) emergency medication did not have the dates to be administered. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 1030- One (1) staff, P.W. did not have an application for employment on file. Rule Reference: .0302 (d)(1)(A) Item 1805- The child care operator has not notified the Division of thirty-one (31) staff member that were hired at ASU Child Development Center. Rule Reference: New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 7/15/2026. Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed the annual evaluation and professional development plan requirements were discussed during today’s visit. Operational policies and personnel policies dates included on the staff and training worksheet were discussed during the visit. Ms. Stegall stated that she understands the requirements and will ensure the requirements are met. - We discussed to move the vinyl bags that stored loose diapers and plastic wipe packaging above diaper changer to another location inaccessible to children under three years old. -We discussed the Cedar mop in the storage area to store the solution container up five (5) feet if only soapy water, but if the solution inside the mop is a chemical it must be locked. The Healthy Social Behaviors Project (HSB) helpline for managing challenging behaviors telephone number (1-888-600-1685 Option 1), online portal, and Talk to the Expert space in the Social-Emotional Connections is available. Healthy Social Behaviors Project (HSB) now have an email for requesting HSB Coaching or training: HSB@ChildCareResourcesInc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: 0326-456L Visit Date: 4/8/2026 Number Present: 94 Completed Date: 4/8/2026 Age: From 0 To 5 Total Minutes: 155 Time In: 01:50 PM Time Out: 04:25 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit was to obtain information related to a self-report received by the Division. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. During today’s visit, Jennifer Eller, Assistant Director, assisted me when I arrived. Moriah Stegall, Administrator, arrived at 2:30p and accompanied me during a walk-through of the facility. During the visit, I discussed the information with Moriah Stegall, Administrator, Jennifer Eller, Assistant Director. Limited monitoring of child care requirements was conducted today to include supervision. There is a concern of inadequate supervision. Based on information obtained, the following was determined. Child was left alone for approximately one (1) minute unattended in the Hummingbird classroom. The administrator and one (1) staff members were interviewed. The administrator stated that teacher and child were on the preschool playground with other teachers and children. The teacher entered the Hummingbird classroom but did not close the exterior door behind her or look behind herself to ensure she was not being followed. A child followed the teacher into the Hummingbird classroom. The exterior door to the playground closed behind the child. The teacher proceeded to walk out of the classroom into the hallway and the classroom door closed behind her. The child was left alone for approximately one (1) minute unattended in the Hummingbird classroom. The teacher self-reported the incident to her via email about 6:00pm on 3/26/2026. Supervision training was completed on 3/9/2026 and all staff were present. The training included reviewing the current supervision policy, talking about common scenarios. The administrator stated this training was prior to this incident. When asked about the actions taken regarding the staff member, the administrator stated that none have been taken until licensing conducted a visit. The administrator stated that the staff member will receive a written warning that will include a coaching plan that will focus on supervision. The staff interviewed stated the incident occurred about 4:20p on 3/26/2026. The staff member involved stated that the group was having snack on the playground that day. There were three (3) other classes out on the playground. She noticed a plate had not been returned to the kitchen. The staff member got the plate and took it to the kitchen. When she was on her way to take the plate in, she noticed a child was upset and stopped to talk to the child. Then entered the Hummingbird classroom exterior door and the door did not shut behind them prior to a child entering the room behind them. She stated the immediately went out the classroom door into the hallway and took the plate to the kitchen and returned to the Hummingbird classroom to go back outside when to see a child standing alone in the classroom. When asked if anyone else witnessed this event, she stated no one was aware of the situation. The video footage was able to be viewed today. The video footage showed the staff member getting the plate and talking with a parent who was picking up a child. The staff member and the parent began walking across the playground towards the building to return the plate. The staff member and parent were stopped by an upset child. The staff member talked with the child. When the child was good, the staff member proceeded to take the plate to the kitchen. The child was following the staff member, and two (2) staff members were sitting to the right of the door the staff member entered. The staff members did not see the child enter the building behind the other staff member. The staff member walked through the classroom and the child entered behind them. The staff member was observed exiting the classroom and immediately returning within a minute. The staff member saw the child standing in the classroom and got the child by the hand and took them back outside. The staff member was not observed talking with another staff member to make them aware of the situation. During today’s visit, I observed three (3) groups with forty-two (42) children and seven (7) adults actively supervising the children. Staff were stationed throughout the playground. One (1) staff member near slide at the building, one (1) at building, one (1) near the shade umbrella in middle of the playground, one (1) sandbox engaged with the children, two (2) staff at the Little Tikes climber, and one (1) at the mud kitchen on the hill. Staff were moving about the outdoor space actively supervising the children. Parents began picking up children at 3:50p. Staff were supervising the pickup and departure of children and parents from the playground to ensure a child did not leave the playground area. I discussed with the administrator to have staff ensure the exterior door shut when they entered the building prior to them moving into the room. Based on the self-report, interview, and video footage the concern regarding supervision is confirmed. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per self-report made on 3/30/2026, a three-year-old child was left alone for approximately 1 minute unattended in the Hummingbird classroom on 3/26/2026. .1801(a)(1-5) Technical assistance was provided as follows: Item 303 per self-report made on 3/30/2026, a three-year-old child was left alone for approximately 1 minute unattended in the Hummingbird classroom on 3/26/2026. We discussed the importance of maintaining adequate supervision and preventing children from entering the building without staff awareness. Staff must communicate clearly and adjust supervision zones any time a staff member leaves the outdoor area. Due to the size of the outdoor space, I recommend the use of walkie talkies to support effective communication. When a staff member needs to go indoors for any reason, they must verbally communicate this to the remaining staff using a walkie talkie or loud voice. Before the staff member exits, all staff outdoors should conduct a head count, confirm numbers with one another, and adjust their supervision zones to ensure full coverage of the area, including the entry/exit pathway. One staff member should position themselves with direct sight of the doorway to ensure that no child follows behind the exiting staff member. Once the head count is completed, numbers are communicated, and zones are adjusted, the staff member may exit the outdoor area. Supervision zones should remain flexible and shift as needed to maintain full visibility of all children at all times. Rule Reference: 10A NCAC 09 .1801(a)(1-5) The facility received a violation regarding supervision today. A follow-up visit may be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). Consultation is provided as follows: -We discussed having staff completing Active Supervision Counts for Home-Based and Center-Based Facilities through Southwestern Child Commission. -We discussed reviewing and updating your supervision procedures for staff to follow that address how to actively supervise all children throughout the day as needed to ensure the staff are following the current procedures. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: 0326-456L Visit Date: 4/8/2026 Number Present: 94 Completed Date: 4/8/2026 Age: From 0 To 5 Total Minutes: 155 Time In: 01:50 PM Time Out: 04:25 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit was to obtain information related to a self-report received by the Division. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. During today’s visit, Jennifer Eller, Assistant Director, assisted me when I arrived. Moriah Stegall, Administrator, arrived at 2:30p and accompanied me during a walk-through of the facility. During the visit, I discussed the information with Moriah Stegall, Administrator, Jennifer Eller, Assistant Director. Limited monitoring of child care requirements was conducted today to include supervision. There is a concern of inadequate supervision. Based on information obtained, the following was determined. Child was left alone for approximately one (1) minute unattended in the Hummingbird classroom. The administrator and one (1) staff members were interviewed. The administrator stated that teacher and child were on the preschool playground with other teachers and children. The teacher entered the Hummingbird classroom but did not close the exterior door behind her or look behind herself to ensure she was not being followed. A child followed the teacher into the Hummingbird classroom. The exterior door to the playground closed behind the child. The teacher proceeded to walk out of the classroom into the hallway and the classroom door closed behind her. The child was left alone for approximately one (1) minute unattended in the Hummingbird classroom. The teacher self-reported the incident to her via email about 6:00pm on 3/26/2026. Supervision training was completed on 3/9/2026 and all staff were present. The training included reviewing the current supervision policy, talking about common scenarios. The administrator stated this training was prior to this incident. When asked about the actions taken regarding the staff member, the administrator stated that none have been taken until licensing conducted a visit. The administrator stated that the staff member will receive a written warning that will include a coaching plan that will focus on supervision. The staff interviewed stated the incident occurred about 4:20p on 3/26/2026. The staff member involved stated that the group was having snack on the playground that day. There were three (3) other classes out on the playground. She noticed a plate had not been returned to the kitchen. The staff member got the plate and took it to the kitchen. When she was on her way to take the plate in, she noticed a child was upset and stopped to talk to the child. Then entered the Hummingbird classroom exterior door and the door did not shut behind them prior to a child entering the room behind them. She stated the immediately went out the classroom door into the hallway and took the plate to the kitchen and returned to the Hummingbird classroom to go back outside when to see a child standing alone in the classroom. When asked if anyone else witnessed this event, she stated no one was aware of the situation. The video footage was able to be viewed today. The video footage showed the staff member getting the plate and talking with a parent who was picking up a child. The staff member and the parent began walking across the playground towards the building to return the plate. The staff member and parent were stopped by an upset child. The staff member talked with the child. When the child was good, the staff member proceeded to take the plate to the kitchen. The child was following the staff member, and two (2) staff members were sitting to the right of the door the staff member entered. The staff members did not see the child enter the building behind the other staff member. The staff member walked through the classroom and the child entered behind them. The staff member was observed exiting the classroom and immediately returning within a minute. The staff member saw the child standing in the classroom and got the child by the hand and took them back outside. The staff member was not observed talking with another staff member to make them aware of the situation. During today’s visit, I observed three (3) groups with forty-two (42) children and seven (7) adults actively supervising the children. Staff were stationed throughout the playground. One (1) staff member near slide at the building, one (1) at building, one (1) near the shade umbrella in middle of the playground, one (1) sandbox engaged with the children, two (2) staff at the Little Tikes climber, and one (1) at the mud kitchen on the hill. Staff were moving about the outdoor space actively supervising the children. Parents began picking up children at 3:50p. Staff were supervising the pickup and departure of children and parents from the playground to ensure a child did not leave the playground area. I discussed with the administrator to have staff ensure the exterior door shut when they entered the building prior to them moving into the room. Based on the self-report, interview, and video footage the concern regarding supervision is confirmed. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per self-report made on 3/30/2026, a three-year-old child was left alone for approximately 1 minute unattended in the Hummingbird classroom on 3/26/2026. .1801(a)(1-5) Technical assistance was provided as follows: Item 303 per self-report made on 3/30/2026, a three-year-old child was left alone for approximately 1 minute unattended in the Hummingbird classroom on 3/26/2026. We discussed the importance of maintaining adequate supervision and preventing children from entering the building without staff awareness. Staff must communicate clearly and adjust supervision zones any time a staff member leaves the outdoor area. Due to the size of the outdoor space, I recommend the use of walkie talkies to support effective communication. When a staff member needs to go indoors for any reason, they must verbally communicate this to the remaining staff using a walkie talkie or loud voice. Before the staff member exits, all staff outdoors should conduct a head count, confirm numbers with one another, and adjust their supervision zones to ensure full coverage of the area, including the entry/exit pathway. One staff member should position themselves with direct sight of the doorway to ensure that no child follows behind the exiting staff member. Once the head count is completed, numbers are communicated, and zones are adjusted, the staff member may exit the outdoor area. Supervision zones should remain flexible and shift as needed to maintain full visibility of all children at all times. Rule Reference: 10A NCAC 09 .1801(a)(1-5) The facility received a violation regarding supervision today. A follow-up visit may be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). Consultation is provided as follows: -We discussed having staff completing Active Supervision Counts for Home-Based and Center-Based Facilities through Southwestern Child Commission. -We discussed reviewing and updating your supervision procedures for staff to follow that address how to actively supervise all children throughout the day as needed to ensure the staff are following the current procedures. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: 0825-070L Visit Date: 8/12/2025 Number Present: 71 Completed Date: 8/12/2025 Age: From 0 To 4 Total Minutes: 125 Time In: 02:00 PM Time Out: 04:05 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit is to follow up on a self-report that was made on 8/5/2025 by Jennifer Eller, Assistant Director regarding supervision. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Jennifer Eller, Assistant Director, during the visit. A signed copy of the visit summary was left on-site with you. Jennifer Eller, Assistant Director, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-two percentage (82%) as of 8/12/2025. The facility operates with a five-star license issued on 10/28/2024. The Special Services/Restrictions includes first shift daytime care only, children in care on ground level only, meets enhanced space, meets enhanced ratios. The self-report was received on 8/5/2025 and sent to me on 8/6/2025. Ms. Stegall stated a supervision incident occurred between 4:15p and 4:30p yesterday afternoon (8/4/025). The teacher involved reported that she had accidentally left a child alone inside. The staff member stated that the three-year-old class was outside on the playground and a group of children needed to use the restroom. The staff member took the group of children to the restroom. While the children were using the restroom the staff member stood in the doorway with the door open to assist with supervision of the children outdoors, and to supervise the children using the restroom. While standing in the doorway parents were walking through the classroom to get their children off the playground. A new parent asked the staff member standing in the doorway if she could assist with locating her child since she was new to the facility. The staff member left the doorway to assist the parent with locating their child on the playground. The exterior door shut, and a three-year-old child was still in the restroom. Less than two (2) minutes later another staff member came into the room to find the child in the block center playing and returned the child to his group outdoors. The administrator was immediately made aware of the situation. She pulled the video footage to see the child was left in the room by himself for one (1) minute and fifty-seven (57) seconds. The administrator spoke with the dad at pick up and stated that she was available to speak with the mom as well. The administrator stated that additional supervision training will be provided during the next professional development day. Staff interviewed reported that the incident occurred during pick-up between 3:45p and 5:00p. The group of children were outside engaged in gross motor play on the playground when a child requested to use the restroom. The staff member took the child to the restroom and stood in the doorway to assist with supervising the child in the restroom and the children outdoors on the playground. While standing in the doorway, parents were coming through the classroom to pick up the children from the playground. One (1) parent wanted to know where their child was, and the staff member directed them to the child’s classroom. The parent stated that they were unaware of where that was as it was their first day picking the child up. The teacher stated that she then left the doorway the exterior door shut, and the child was still in the restroom. The teacher stated that she was made aware of the situation when the child was returned to the playground by another teacher. The other staff member interviewed that found the child in the classroom stated that she was out on the playground when one (1) of her children came to her and requested to use the restroom. She then walked the child down the hill and to the exterior door of the classroom which was shut. The staff member used their access card to open the door and let the child in to use the restroom. When the staff and child entered the classroom she found the child playing with the trains in the block center. As she entered the room the child she brought in went to use the restroom and she moved towards the child to ask What are you doing? The child responded I went to pee. She went on to ask the child if they were ok. The staff member returned the child back to their group on the playground and letting the child’s teacher know what had happened. The staff member then immediately reported the incident to the Assistant Director and the Administrator. The video footage was unable to be viewed today due to the administrators absence and the administrator is the only one who has access to the video footage. While observing outdoor play today, I observed a supervision incident while the children were outside engaged in play on the playground. Two (2) groups of children aged two to four years old were on the preschool playground. One (1) child was playing on the hill in the mud kitchen under the tree. The staff were stationed throughout the playground but at 3:20p the staff’s backs were turned to the child and one (1) staff member under the covered area at the picnic table noticed the child on the hill and immediately turned to where she could see the child on the hill. We discussed outdoors the need to establish zones, frequently scanning and counting, and communicating with one another to ensure that staff are able to see and hear the children at all times. Based on the report, staff interviews, according to the report, it was confirmed that supervision was out of compliance on 8/4/2025. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per self-report made on 8/4/2025 a three year old child was left unsupervised for approximately one (1) minute and fifty-seven (57) seconds. .1801(a)(1-5) Technical assistance was provided as follows: Item 303 per self-report made on 8/4/2025 a three year old child was left unsupervised for approximately one (1) minute and fifty-seven (57) seconds. We discussed children must be seen and heard at all times. When staff is stationed in the doorway to allow children to use the restroom in the afternoon, if they need to leave the doorway for any reason they need to have another staff member come take their place with supervising the children using the restroom. Rule reference: 10A NCAC 09 .1801(a)(1-5) Achieving Compliance: The facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/26/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education ATTN: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed conducting a staff meeting to review adequate supervisions and providing an interactive scenario for staff to be involved in. -I recommend reaching out to Watauga Children’s Council for additional active supervision training. -Due to the facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). -Followed up regarding the Dechoker/anti-choking device that is on-site in the classrooms. The Dechoker/anti-choking device has not been approved by the Food and Drug Administration (FDA) has not approved over-the-counter anti-choking devices and is prohibited from being used in licensed child care facilities. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: 0825-070L Visit Date: 8/12/2025 Number Present: 71 Completed Date: 8/12/2025 Age: From 0 To 4 Total Minutes: 125 Time In: 02:00 PM Time Out: 04:05 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit is to follow up on a self-report that was made on 8/5/2025 by Jennifer Eller, Assistant Director regarding supervision. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Jennifer Eller, Assistant Director, during the visit. A signed copy of the visit summary was left on-site with you. Jennifer Eller, Assistant Director, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-two percentage (82%) as of 8/12/2025. The facility operates with a five-star license issued on 10/28/2024. The Special Services/Restrictions includes first shift daytime care only, children in care on ground level only, meets enhanced space, meets enhanced ratios. The self-report was received on 8/5/2025 and sent to me on 8/6/2025. Ms. Stegall stated a supervision incident occurred between 4:15p and 4:30p yesterday afternoon (8/4/025). The teacher involved reported that she had accidentally left a child alone inside. The staff member stated that the three-year-old class was outside on the playground and a group of children needed to use the restroom. The staff member took the group of children to the restroom. While the children were using the restroom the staff member stood in the doorway with the door open to assist with supervision of the children outdoors, and to supervise the children using the restroom. While standing in the doorway parents were walking through the classroom to get their children off the playground. A new parent asked the staff member standing in the doorway if she could assist with locating her child since she was new to the facility. The staff member left the doorway to assist the parent with locating their child on the playground. The exterior door shut, and a three-year-old child was still in the restroom. Less than two (2) minutes later another staff member came into the room to find the child in the block center playing and returned the child to his group outdoors. The administrator was immediately made aware of the situation. She pulled the video footage to see the child was left in the room by himself for one (1) minute and fifty-seven (57) seconds. The administrator spoke with the dad at pick up and stated that she was available to speak with the mom as well. The administrator stated that additional supervision training will be provided during the next professional development day. Staff interviewed reported that the incident occurred during pick-up between 3:45p and 5:00p. The group of children were outside engaged in gross motor play on the playground when a child requested to use the restroom. The staff member took the child to the restroom and stood in the doorway to assist with supervising the child in the restroom and the children outdoors on the playground. While standing in the doorway, parents were coming through the classroom to pick up the children from the playground. One (1) parent wanted to know where their child was, and the staff member directed them to the child’s classroom. The parent stated that they were unaware of where that was as it was their first day picking the child up. The teacher stated that she then left the doorway the exterior door shut, and the child was still in the restroom. The teacher stated that she was made aware of the situation when the child was returned to the playground by another teacher. The other staff member interviewed that found the child in the classroom stated that she was out on the playground when one (1) of her children came to her and requested to use the restroom. She then walked the child down the hill and to the exterior door of the classroom which was shut. The staff member used their access card to open the door and let the child in to use the restroom. When the staff and child entered the classroom she found the child playing with the trains in the block center. As she entered the room the child she brought in went to use the restroom and she moved towards the child to ask What are you doing? The child responded I went to pee. She went on to ask the child if they were ok. The staff member returned the child back to their group on the playground and letting the child’s teacher know what had happened. The staff member then immediately reported the incident to the Assistant Director and the Administrator. The video footage was unable to be viewed today due to the administrators absence and the administrator is the only one who has access to the video footage. While observing outdoor play today, I observed a supervision incident while the children were outside engaged in play on the playground. Two (2) groups of children aged two to four years old were on the preschool playground. One (1) child was playing on the hill in the mud kitchen under the tree. The staff were stationed throughout the playground but at 3:20p the staff’s backs were turned to the child and one (1) staff member under the covered area at the picnic table noticed the child on the hill and immediately turned to where she could see the child on the hill. We discussed outdoors the need to establish zones, frequently scanning and counting, and communicating with one another to ensure that staff are able to see and hear the children at all times. Based on the report, staff interviews, according to the report, it was confirmed that supervision was out of compliance on 8/4/2025. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per self-report made on 8/4/2025 a three year old child was left unsupervised for approximately one (1) minute and fifty-seven (57) seconds. .1801(a)(1-5) Technical assistance was provided as follows: Item 303 per self-report made on 8/4/2025 a three year old child was left unsupervised for approximately one (1) minute and fifty-seven (57) seconds. We discussed children must be seen and heard at all times. When staff is stationed in the doorway to allow children to use the restroom in the afternoon, if they need to leave the doorway for any reason they need to have another staff member come take their place with supervising the children using the restroom. Rule reference: 10A NCAC 09 .1801(a)(1-5) Achieving Compliance: The facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/26/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education ATTN: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed conducting a staff meeting to review adequate supervisions and providing an interactive scenario for staff to be involved in. -I recommend reaching out to Watauga Children’s Council for additional active supervision training. -Due to the facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). -Followed up regarding the Dechoker/anti-choking device that is on-site in the classrooms. The Dechoker/anti-choking device has not been approved by the Food and Drug Administration (FDA) has not approved over-the-counter anti-choking devices and is prohibited from being used in licensed child care facilities. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: 0825-070L Visit Date: 8/12/2025 Number Present: 71 Completed Date: 8/12/2025 Age: From 0 To 4 Total Minutes: 125 Time In: 02:00 PM Time Out: 04:05 PM Time In: Time Out: List to Use: Center Type Of Visit: Self Report Announced/Unannounced: Unannounced The purpose of today’s visit is to follow up on a self-report that was made on 8/5/2025 by Jennifer Eller, Assistant Director regarding supervision. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Jennifer Eller, Assistant Director, during the visit. A signed copy of the visit summary was left on-site with you. Jennifer Eller, Assistant Director, assisted me today. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-two percentage (82%) as of 8/12/2025. The facility operates with a five-star license issued on 10/28/2024. The Special Services/Restrictions includes first shift daytime care only, children in care on ground level only, meets enhanced space, meets enhanced ratios. The self-report was received on 8/5/2025 and sent to me on 8/6/2025. Ms. Stegall stated a supervision incident occurred between 4:15p and 4:30p yesterday afternoon (8/4/025). The teacher involved reported that she had accidentally left a child alone inside. The staff member stated that the three-year-old class was outside on the playground and a group of children needed to use the restroom. The staff member took the group of children to the restroom. While the children were using the restroom the staff member stood in the doorway with the door open to assist with supervision of the children outdoors, and to supervise the children using the restroom. While standing in the doorway parents were walking through the classroom to get their children off the playground. A new parent asked the staff member standing in the doorway if she could assist with locating her child since she was new to the facility. The staff member left the doorway to assist the parent with locating their child on the playground. The exterior door shut, and a three-year-old child was still in the restroom. Less than two (2) minutes later another staff member came into the room to find the child in the block center playing and returned the child to his group outdoors. The administrator was immediately made aware of the situation. She pulled the video footage to see the child was left in the room by himself for one (1) minute and fifty-seven (57) seconds. The administrator spoke with the dad at pick up and stated that she was available to speak with the mom as well. The administrator stated that additional supervision training will be provided during the next professional development day. Staff interviewed reported that the incident occurred during pick-up between 3:45p and 5:00p. The group of children were outside engaged in gross motor play on the playground when a child requested to use the restroom. The staff member took the child to the restroom and stood in the doorway to assist with supervising the child in the restroom and the children outdoors on the playground. While standing in the doorway, parents were coming through the classroom to pick up the children from the playground. One (1) parent wanted to know where their child was, and the staff member directed them to the child’s classroom. The parent stated that they were unaware of where that was as it was their first day picking the child up. The teacher stated that she then left the doorway the exterior door shut, and the child was still in the restroom. The teacher stated that she was made aware of the situation when the child was returned to the playground by another teacher. The other staff member interviewed that found the child in the classroom stated that she was out on the playground when one (1) of her children came to her and requested to use the restroom. She then walked the child down the hill and to the exterior door of the classroom which was shut. The staff member used their access card to open the door and let the child in to use the restroom. When the staff and child entered the classroom she found the child playing with the trains in the block center. As she entered the room the child she brought in went to use the restroom and she moved towards the child to ask What are you doing? The child responded I went to pee. She went on to ask the child if they were ok. The staff member returned the child back to their group on the playground and letting the child’s teacher know what had happened. The staff member then immediately reported the incident to the Assistant Director and the Administrator. The video footage was unable to be viewed today due to the administrators absence and the administrator is the only one who has access to the video footage. While observing outdoor play today, I observed a supervision incident while the children were outside engaged in play on the playground. Two (2) groups of children aged two to four years old were on the preschool playground. One (1) child was playing on the hill in the mud kitchen under the tree. The staff were stationed throughout the playground but at 3:20p the staff’s backs were turned to the child and one (1) staff member under the covered area at the picnic table noticed the child on the hill and immediately turned to where she could see the child on the hill. We discussed outdoors the need to establish zones, frequently scanning and counting, and communicating with one another to ensure that staff are able to see and hear the children at all times. Based on the report, staff interviews, according to the report, it was confirmed that supervision was out of compliance on 8/4/2025. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Per self-report made on 8/4/2025 a three year old child was left unsupervised for approximately one (1) minute and fifty-seven (57) seconds. .1801(a)(1-5) Technical assistance was provided as follows: Item 303 per self-report made on 8/4/2025 a three year old child was left unsupervised for approximately one (1) minute and fifty-seven (57) seconds. We discussed children must be seen and heard at all times. When staff is stationed in the doorway to allow children to use the restroom in the afternoon, if they need to leave the doorway for any reason they need to have another staff member come take their place with supervising the children using the restroom. Rule reference: 10A NCAC 09 .1801(a)(1-5) Achieving Compliance: The facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/26/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education ATTN: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed conducting a staff meeting to review adequate supervisions and providing an interactive scenario for staff to be involved in. -I recommend reaching out to Watauga Children’s Council for additional active supervision training. -Due to the facility received a violation regarding supervision today. A follow-up visit will be conducted in the near future to determine if staff are adequately supervising children per Child Care Rule 10A NCAC 09 .1801(a)(1-5). -Followed up regarding the Dechoker/anti-choking device that is on-site in the classrooms. The Dechoker/anti-choking device has not been approved by the Food and Drug Administration (FDA) has not approved over-the-counter anti-choking devices and is prohibited from being used in licensed child care facilities. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0302 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0604 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0605 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0608 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/10/2025 Number Present: 85 Completed Date: 7/10/2025 Age: From 0 To 5 Total Minutes: 320 Time In: 10:10 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. Kaitlyn Marshall, Child Care Consultant accompanied me. An electronic signed copy of the visit summary was left on-site with you. Moriah Stegall, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, naptime, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-seven percent (77%) as of 6/30/2025. The facility is owned by Appalachian State University. Permit type – Five (5) Star Rated License, issued 10/28/2024. Special Services/Restrictions – First shift, children in care on ground level only, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 7/18/2024. The last fire drill was practiced on 6/19/25. The last shelter-in-place drill was practiced on 6/17/25. The last playground inspection was documented on 6/19/25. The last fire inspection was approved on 7/7/25. The last sanitation inspection was conducted on 4/16/2025 with thirteen (13) demerits for a superior classification. The last lead water testing was completed on 7/6/2024. The next testing is due on or before 7/6/2027. The last lead paint and asbestos testing was completed on 1/17/2025 and 6/19/2025. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response (EPR) plan was current and updated on 7/1/25. The approved curriculum for four-year-old children is Creative Curriculum. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of one to three-year-old children were engaged in lunch, routine diaper changing, and preparing for nap. During nap staff were stationed to be able to supervise the children. Natural lighting was used during nap time with calming music playing. Space 2 (Dogwood) is currently closed. The classroom did uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play when I arrived. After gross motor play, the group transitioned indoors to wash hands and prepare for lunch. When lunch concluded, the children put away their lunch boxes in their cubby, used the restroom, washed hands, and went to their cot for nap. While monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. When the group transitioned indoors, the group washed hands and prepared for lunch. After lunch, the children prepared for nap. During nap, the staff member sat between the cots with natural lighting the room and music was calm. Space 5 (Pine) currently closed and used as storage. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch. When lunch concluded, the group prepared for nap. During nap time, the natural lighting and calming music was used to assist the children with resting. While monitoring nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. After gross motor play the group transitioned indoors to prepare for lunch and nap. During nap the group used natural lighting and calming music to assist the children with resting. Space 9 (Dandelion) group of infant- to three-year-old children were engaged in outdoor gross motor play. After gross motor play the group prepared for lunch and nap. During nap time natural lighting was used with calming music. The staff were spaced out to supervise the children. Space 10 (Sunflower) group of one- to three-year-old children were engaged in outdoor gross motor play. After gross motor play, the group transitioned indoors to prepare for lunch and nap. During nap time, natural lighting and calm low music was used to assist children with resting. Lunch in the old building is brought from home, and the facility provides any missing components. Lunch is provided in the new building. Lunch today consisted of chicken tenders, bread, oranges, hashbrowns, and milk was provided. Today, we followed up on the group of infant to two year old children's transition plan. Ms. Stegall stated she has a phase in plan that will be completed by the end of August. Ms. Stegall did share the plan with me during the visit. I will follow up at the end of August to ensure the plan has been completed. While monitoring outdoors, I observed anchors exposed and compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. Wooden mud kitchen had sharp edges around the sink area. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Rust showing on the gate between the preschool and toddler playground. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The previous fire inspection was conducted on 6/19/24. However, the recent inspection was not completed till July 7, 2025. 10A NCAC 09 .0304(a) 614 Bed, cribs, playpens, cots or mats were not placed at least 18" apart or separated by partitions when in use. Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. 15A NCAC 18A .2821(e) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Monthly fire drill was missed for the month of April 2025. .0604(t); .0302(d)(5) 807 A safe indoor and outdoor environment was not provided for the children. Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. 10A NCAC 09 .0601(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. 10A NCAC 09 .0803(1)(a & b) 1030 Application for employment and date of birth was not on file for all staff. Application for employment was not on file for two (2) staff. .0302(d)(1)(A) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. .0605(k)(1-4) 1907 A copy of the Prevention of Shaken Baby and Abusive Head Trauma policy was not given to or explained to parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. One (1) child did not have an acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy on file for review. .0608(b) Technical assistance was provided as follows: Item 106- Annual fire inspection was not completed within twelve (12) months of the previous inspection. The fire inspection was completed on July 7, 2025. The administrator stated that she did reach out to the inspector prior to the expiration date of the previous inspection. However, the fire marshal did not complete the required inspection until July 7, 2025. Rule reference: 10A NCAC 09.0304(a) Item 614- Space #7 during nap time, I observed the three (3) cots in the block center were closer than eighteen (18) inches apart. The one (1) cot against the cubbies measured fourteen (14) inches from the one (1) cot against the wall, and seventeen (17) inches from the cot against the shelf. We discussed that cot placement will need to placed at least eighteen (18) inches apart. Rule reference: 15A NCAC 18A.2821(e) Item #805- In your letter of compliance, include a statement that indicates how you will ensure fire drills are conducted each month. We discussed training additional staff on how to conduct these drills in the event of staff shortages. Rule References: 10A NCAC 09.0604(t); .0302(d)(5) Item 807- Rust showing on the gate between the preschool and toddler playground. Wooden mud kitchen had sharp edges around the sink area. Rock climbing wall metal anchor was exposed. We discussed to have the maintenance team mitigate the rust and remove or repair the wooden mud kitchen. The anchor will need to be covered. Rule reference: 10A NCAC 09 .0601(a) Item 842- Space #3, while monitoring medications, I observed one (1) sunscreen on site without a permission to administer mediation form. We discussed staff need to ensure the permission to administer medication form must be completed prior to medication being used in the classroom. Rule reference: 10A NCAC 09 .0803(1)(a)&(b) Item #1030- An application must be on file for each staff. We discussed that the University maintains the applications on file in their system electronically. You stated you do not have access to these applications once the employee has been hired. Plan to request a copy of the application from the University or have the staff member complete the application that is available on the Division’s website under the Provider tab>Provider Docs and Forms. We discussed these applications are needed to verify staff information such as years of experience, education and birthdate. In your letter of compliance, please include a statement that indicates the files for the two (2) staff members, CP and DH contain completed applications. Rule reference: 10A NCAC 09.0302(d)(1)(A) Item 1867 -Rubber mulch less than one (1) inch at slide exit and two (2) inches in fall zone. Compacted mulch around the rock climber measuring six (6) feet five (5) inches in height. We discussed that surfacing would need to be ordered and installed to meet the required depth of mulch (rubber or wood) to meet the critical height requirement. Rule reference: 10A NCAC 09.0605(k)(1-4) Item #1907- The parent of the one (1) child must sign the acknowledgement for the Shaken Baby Syndrome and Abusive Head Trauma Policy. Once you receive this signed acknowledgement, plan to place it in the child’s file. In your letter of compliance, please include a statement that indicates this acknowledgement has been signed by the parent. Rule reference: 10A NCAC 09.0608(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: · Facility name · Facility ID# · Date of visit · Violation item number · Statement of compliance I must receive your compliance statement by 7/24/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. - We discussed to begin reviewing the Quality Rating and Improvement System (QRIS) page on the Division's website to determine which pathway is best for your facility. I left proposed the proposed pathway #1 and #2 with you along with supporting documents. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0901 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0514 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0713 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0901 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2204 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/29/2025 Number Present: 90 Completed Date: 1/29/2025 Age: From 0 To 5 Total Minutes: 325 Time In: 10:05 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant, Monica Houck, Lead Licensing Consultant, and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Upon arrival, we were greeted by Moriah Stegall, Administrator. I explained the reason for my visit and introduced Monica Houck, Lead Licensing Consultant, accompanying me on this visit. Moriah Stegall, Administrator, was available during the visit. The center’s compliance history was reviewed with the operator. The program’s compliance history was seventy-five (75%) percent as of 1/28/2025. We discussed that the license must maintain at least seventy-five (75%) percent for an eighteen-month period. Any violations cited during today’s visit may warrant a follow-up visit. If the facility falls below a seventy-five percent (75%) compliance history, the Division may issue a provisional or Notice of Compliance per 10A NCAC 09 .2204 (5); GS-110-90 4(c-d). Limited monitoring of child care rules was conducted today, including but not limited to indoor and outdoor space, staff record, supervision and interactions. The program’s las annual compliance visit was conducted on 7/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS-SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Five (5) Star Rated License effective 10/28/2024. Special Services/Restrictions – first shift (daytime care), children in care on ground level only, meets enhanced ratios, and meets enhanced space. The last fire drill was practiced on 12/1/2024. The last emergency drill, shelter in place drill, was practiced on 12/3/2024. The last fire inspection was approved on 6/19/2024. The program’s most recent sanitation inspection was completed on 5/29/2024, with twenty-one (21) demerits. The Emergency Medical Care Plan is posted and current. The incident log is in use and maintained. The program does not provide transportation. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/16/2024. Space 1 A/B (Cardinal) group of infants to two-year-old children were eating lunch at the tables. After lunch, the children washed hands and transitioned to their cots for nap. Space 2 (Dogwood) is currently closed. Space 3 (Willow) group of three- to five-year-old children were engaged in lunch. Space 4 A/B (Juniper) group of two- to three-year-old children were eating lunch. While monitoring the room, I observed three (3) outlets uncovered. The staff member corrected this during the visit. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) was removed from license due to space being used by Valle Crusis as an emergency relocation due to Tropical Storm Helene. Space 6 (Honeysuckle) group of two- to five-year-old children were engaged group time with one child engaged in play with links. One (1) staff member lead the group story time while one (1) staff member prepared lunch plates. After group time, the children got their water bottle from their cubby, washed hands, and went to the table for lunch. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in free play with trucks, blocks, bugs, light table, free art. I observed lunch, the children get water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in free play exploring the room, routine diaper changing, and one on one activity with staff member. Space 9 (Dandelion) group of infant- to two-year-old children were engaged in free play and routine diaper change. One (1) child came in late and the staff greeted the child upon arrival, the parent assisted the child with washing hands upon arrival. While monitoring medications, I observed one (1) sunscreen medication form was expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in free play. While monitoring medications, I observed one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. Lunch today in the new building consisted of turkey wrap, broccoli, and tater tots. No milk was served. The children in the old building have a nutritional opt out form on file and bring their meals and snacks from home. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 501 Meals/snacks did not comply with the Meal Patterns for Children in Child Care Programs. In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. 10A NCAC 09 .0901(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space #3, three (3) outlets uncovered. 10A NCAC 09 .0604(c) 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. In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. .0803(12) Technical assistance was provided as follows: Item #501 In space #6 and #7, while observing lunch, the children got their water bottle out of their cubbies to drink with their lunch. No milk was observed being served with lunch. We discussed that a milk component is required and would need to be provided for lunch. Rule Reference: 10A NCAC 09 .0901(a) Item # 812 In space #3, three (3) outlets uncovered. The staff member corrected this during the visit. Item #849 In space #10, one (1) diaper cream that expired 1/2025 and the permission to administer medication expired 9/18/2024. In space #9 one (1) sunscreen medication form was expired. We discussed to look closely at the medications and the forms when conducting a monthly check to ensure that the medication and forms are in compliance. Rule Reference: 10A NCAC 09 .0803(12) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/12/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Due to Tropical Storm Helene guidance was provided to allow more time to achieve compliance: *One (1) staff hired on 12/9/24 has a TB Test dated 9/14/22. We discussed that a TB Test/Screening must be completed within 12 months prior to hire. The staff will need to have an updated TB Test/Screening completed. Once completed, plan to notify the consultant with the date the negative TB Test results or TB Screening was completed and on file. *One (1) staff hired on 4/11/24 and rehired on 1/6/25 has a North Carolina Public Schools staff medical report dated 2/7/24 that does have a statement included that the staff is emotionally and physically capable to care for children on a daily basis. It is recommended for the staff to take the current completed form to the health care professional along with the DCDEE staff medical report form to have the information transferred and allow the health care professional to answer the question if the staff is emotionally and physically capable of caring for children on a daily basis. Plan to notify the consultant once the staff has 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) *The staff listed below do not have a signed statement on file to document the operational and/or personnel policies have been reviewed. Plan to review the operational and personnel policies with staff and notify the consultant once all staff below have a signed statement on file. -A. Horton, A. McCarty, D. Herbster, M. Godbey, C. Harvel, P. Baucom, A. Waldrop, K. McClellan, O. Hackney, E. Blackwell, T. Williams, E. Radcliff, and K. Tate. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (g) Consultation is provided as follows: We discussed grouping of infants through two year old children. Per requirements. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (4) when determined to be developmentally appropriate by the operator and parent, a child age two or older may be placed one age level above his or her chronological age without affecting the staff/child ratio for that group. This provision shall be limited to one child per group; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; The enrollment worksheet does not accurately reflect grouping of children. A follow-up visit will be scheduled to re-measure classrooms to ensure that the spaces accurately reflect the space set up and space capacity. One (1) staff hired on 12/9/24 has valid American Heart Association Heartsaver K-12 Schools which is valid for CPR only. The staff will need to complete age appropriate First Aid training on or before 3/9/25. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh 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 .0605 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh 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 .2204 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh 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: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 8/5/2024 Number Present: 73 Completed Date: 8/5/2024 Age: From 0 To 5 Total Minutes: 170 Time In: 10:10 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to verify correction of violations documented during the unannounced annual compliance visit on 7/18/2024. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Jeannie Mash, Assistant Director of Student Learning during the visit. A signed copy of the visit summary was left on-site with you. Jeannie Marsh, Assistant Direct of Student Learning accompanied me today. The indoor and outdoor environment used by the children was monitored today. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in outdoor gross motor play. Two (2) staff members were sitting on the ground with the children in the shade. Space 9 (Dandelion) group of one- to three-year-old children were engaged in outdoor gross motor play with sand, barn, soft blocks, trikes, and books. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in outdoor gross motor play with trikes, climber, slide, and sand. The staff were moving about the outdoor space supervising the children. Space 10 (Sunflower) group of infant- to two-year-old children were engaged in outdoor gross motor play and one (1) child was indoor with one (1) staff member for a individual bottle feeding. The remaining seven (7) children were outdoors engaged in gross motor play with sand, barn, soft blocks, and trikes. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member was walking around the outdoor area, and one staff member was standing near the tunnel. Space 4C (Pine) classroom is currently closed. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. The staff was standing near the trike area and the other staff member was near the climber supervising the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, and lunch. One (1) staff member in the sleep area with three (3) children one (1) was in the crib asleep, one (1) was sitting in boppy pillow, and one (1) was being held by the staff member, and two (2) staff were with the children eating at the tables. Space 5 (Wildflower) is the gross motor classroom. The following violations documented during the 7/18/2024 visit were monitored for compliance during this visit: 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 facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024.– Per letter of compliance received on 7/31/2024 fire inspection is current. A calendar reminder has been added to the center calendar for next year. 705- Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. Per letter of compliance received on 7/31/2024, a contractor has been scheduled to fix the chipping paint. Tape is covering the chipping paint until the contractor/painter arrives. 8/1/2024, the administrator stated that the chipping paint was repainted. During the visit, I observed the chipping paint is still present outside of the wildflower exterior door and side of the building. 824- Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. Per letter of compliance received on 7/31/2024, The protrusion has been removed and the fence height is once again 4 feet tall. During the visit, the fence measured four (4) feet the rubber bumper was removed from the base of the fence. 842- A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. Per letter of compliance received on 7/31/2024, A written authorization form from a pediatrician is on-site for the child’s EpiPen. Updated permission to administer medication for was emailed on 8/2/2024. During the follow-up visit, the form was observed in the classroom. 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. Per letter of compliance received on 7/31/2024, All expired sunscreens have been sent home. All sunscreen on site has current, signed authorization forms. Staff have been instructed to write sunscreen and medication expiration dates on calendars as a reminder. During the follow-up visit, all medications were current and permission to administer medication forms were completed and up to date. 871- Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. Per letter of compliance, The staff responsible has been reprimanded and reeducated. All staff will be reeducated on safe sleep practices on 8/13/24. During the follow-up visit, all sleep charts were completed per safe sleep policy and up to date. 1032- Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. The staff member has an appointment for Thursday, August 8th. 1033- On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. Per letter of compliance received on 7/31/2024. Extension was requested on 8/2/2024 till 8/16/2024. An extension was approved for one (1) week. Current medical report will be due by close of business on 8/9/2024. 1035- Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. Per letter of compliance received on 7/31/2024, all staff have signed and put emergency information forms on file. 1041- Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1048- All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. First Aid training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired First Aid training. 1049- All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. CPR training was completed late. Per letter of compliance received on 7/31/2024, all staff have current, unexpired CPR training. 1321- Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. Child medical record was submitted late. Per letter of compliance received on 7/31/2024, all children have current medical exams on file. 1323- Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. Child immunization records were submitted late. Per letter of compliance received on 7/31/2024, all children have current immunizations on file. 1757- A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. Per letter of compliance received on 7/31/2024, AJohnson has a current provisional background check from DCDEE. 1867- The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. Per letter of compliance received on 7/31/2024, Additional mulch has been added to the base of the grey climber; mulch depth is now over 6 inches. Due to rainstorm, the mulch has washed, and the mulch depth measured three (3) inches. The facility will need to look at ways to keep the mulch from washing or have a different approved surfacing installed. 1874- The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** The staff members completed the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy late. Per letter of compliance received on 7/31/2024,sStaff are sent to University HR onboarding when first hired prior to coming to the CDC. Once they physically on site at the CDC, they have 2+ weeks of trainings and observation prior to being left with children. Staff all have signed Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy forms. 1897- The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. The staff members completed the Recognizing and Responding to Suspicions of Child Maltreatment training late. Per letter of compliance received on 7/31/2024, all staff have Child Maltreatment training complete. 1898- Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. The staff members completed the health and safety trainings late. Per letter of compliance received on 7/31/2024, staff hired 9/20/22 was a student worker for a short time and only recently returned as a full-time teacher. All staff employed at the Child Development Center for more than one year have completed Health and Safety training at this time. The following repeat violations were documented for mulch depth and chipping paint. As stated, an extension of one (1) week was approved for the staff medical report and TB. The completed medical report and TB must be submitted by close of business on 8/9/2024. All violations must be corrected immediately and a compliance letter verifying this must be received by the established due date. At the time of today’s visit, a compliance letter was received on 7/31/2024 and updated on 8/1/2024 with additional supporting documents submitted on 8/2/2024. Violations requiring additional time for correction, must be addressed immediately to ensure a safe environment for the children in your care. This may require you to stop using part of a space/block it off, and/or make other modifications while waiting on supplies (ex: mulch) to be delivered. Continued noncompliance may result in an administrative action per Child Care Rule 10A NCAC 09 .2204(6). The following violation(s) were documented: Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. .0601(c) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. This is a repeat violation. .0605(k)(1-4) Technical assistance was provided as follows: Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was still observed around the exterior door frames to the wildflower exterior door that leads to the playground, along with chipping paint on the side of the building beside the wildflower door. This is a repeat violation. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured three (3) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. When asked about the mulch that was delivered, the assistant director stated that it was delivered and spread. However, due to the bad rainstorm they had the mulch washed. -I suggest having more mulch brought in to be spread around the climbing structure or look for a different approved surfacing to have installed that would not wash as easy. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/19/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: -Mulch depth I recommend having more mulch brought in or look for a different type of approved surfacing to have installed around the rock climber. If you cannot remain out of compliance with the appropriate surfacing I would have the rock climber removed from the playground. - I suggest the use of walkie talkies during emergency situations in order for the staff to get in contact with administration quickly to assist with contacting emergency personnel. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhh If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0302 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0605 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0606 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0608 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0901 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 7/18/2024 Number Present: 82 Completed Date: 7/19/2024 Age: From 0 To 5 Total Minutes: 305 Time In: 10:10 AM Time Out: 03:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A handwritten visit summary was completed due to time constraints. Beth Archer, Child Care Consultant accompanied me on this visit. Upon arrival, we were greeted by Moriah Stegall, Administrator. We reviewed the reason for our visit with Ms. Stegall. Ms. Stegall was available during the visit. The program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The last annual compliance visit was conducted on 7/28/2023. The last fire drill was practiced on 6/21/24. The last shelter-in-place drill was practiced on 6/2/24. The last playground inspection was documented on 6/10/24. The last fire inspection was approved on 6/19/24, two (2) months after the previously approved fire inspection. The last sanitation inspection was conducted on 5/29/2024 with twenty-one (21) demerits for an approved classification. The last lead and asbestos testing is in progress. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plan was last updated on 6/26/2024. The approved curriculum for four-year-old children is Creative Curriculum. All medications were monitored, and the following medication concerns were observed: In the hummingbird classroom, three (3) sunscreen permission to administer medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the sunflower classroom, one (1) emergency medication was monitored and did not have a permission to administer medication form completed by the parent. In the cardinal classroom, one (1) athletic foot cream was monitored. The permission form was completed to use for the child’s diaper rash. However, the warning label on the athletic foot cream stated to ask the doctor before use on children under two (2). When I asked if the facility had documentation from the doctor to use on the child, the teacher stated no. We discussed the need to have doctor documentation for this medication to be applied to the child’s diaper rash. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-seven percent (87%) as of 7/17/2024. This facility is owned and operated by Appalachian State University. During the visit, I monitored the indoor and outdoor environment used by the children. Space 1 A/B (Cardinal) group of infants to two-year-old children were engaged in naptime, outside, and indoor gross motor play. One (1) staff member was indoors with three (3) children sleeping, one (1) staff member was outdoors with two (2) children playing, and one (1) staff member was indoors with three (3) children engaged in gross motor play. Space 3 (Willow) group of three- to five-year-old children were engaged in outdoor gross motor play. Space 2 (Dogwood) is currently closed. The classroom did have six (6) uncovered outlets. The outlets will need to be covered prior to being used by children. Space 4 A/B (Juniper) group of one- to two-year-old children were engaged in outdoor gross motor play. One (1) staff member brought three (3) children indoors for routine diaper change. After diaper change one (1) staff member began preparing for lunch. Space 4C (Pine) classroom is currently closed. Space 5 (Wildflower) is the gross motor classroom. Space 8 (Chickadee), the group of infants to two-year-old children were engaged in naptime. One (1) staff member was rocking a child, one (1) staff member was holding a child, and one (1) staff member was sitting with a child. While reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff member completed the chart during the visit. Space 9 (Dandelion) group of one- to three-year-old children were engaged in nap time. One (1) staff member was sitting in the middle of the room, and one (1) staff member was sitting with a child. Space 7 (Hummingbird) group of two- to five-year-old children were engaged in nap time. One (1) staff member went on lunch break during the walk through, and one (1) staff member was supervising the children. While checking the medications three (3) sunscreen permission to administer medication forms were observed to be expired, and two (2) medications were expired. Space 10 (Sunflower) group of one- to three-year-old children were engaged in nap time. One (1) staff member was standing on the left side of the room and one (1) staff member was sitting with a child on the right side of the room. While monitoring medication, I observed one (1) emergency medication on-site without a permission to administer medication form. During the visit, we discussed the lighting during nap time needed to be lighter. The staff members turned on the fairy lights and adjusted the curtains during the visit to lighten the room on the right side. Space 6 (Honeysuckle) group of three- to five-year-old children were engaged in outdoor gross motor play. Lunch in the old building is brought from home and children have a nutritional opt out form on file. Lunch in the new building is provided. Staff and children’s files were monitored during the visit. We monitored eight (8) new staff, and four (4) existing staff files. The staff and training worksheet was received prior to today's visit via email. We monitored ten (10) children’s files and completed the Children’s Record form. The program is approved to provide transportation. However, during the annual compliance visit conducted on 7/28/2023, the consultant noted that transportation was not monitored. The provider stated that they do not provide transportation. During today’s visit, the administrator and I discussed transportation. The administrator stated that transportation is not provided. I asked the administrator to submit a statement on letterhead requesting to remove transportation from the license. The administrator typed the statement during the visit and submitted it to me. I removed transportation from the license. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024 10A NCAC 09 .0304(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. .0601(c) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. GS 110-91(6); .0605((i) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 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. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. .0803(12) 871 Center staff did not comply with the safe sleep policy. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. .0701(a) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. .1102(d) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. 10A NCAC 09 .0302(d)(2) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. G.S. 110-90.2(b) & (d) & .2703(e) 1867 The depth of the loose surfacing was not based on critical height of the equipment. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. .0605(k)(1-4) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. .1102(a) Technical assistance was provided as follows: Item # 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. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. The facility did not obtain a fire inspection completed within twelve (12) months of the previous inspection. The previous fire inspection on file is dated 4/4/2023 and the current fire inspection was completed 6/19/2024. - I suggest documenting on your calendar to reach out to the Fire Marshal at least one (1) month prior to the previous inspection date to ensure that you are on schedule. Item #705 Equipment and furnishings were not sturdy, stable and free of hazards. 10A NCAC 09 .0601 SAFE ENVIRONMENT (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. While monitoring the outdoor space, chipping and flaking paint was observed around the exterior door frames to the classroom. -I suggest sanding and repainting the exterior door frames to ensure that the outdoor space is free of hazards. I also suggest checking the exterior door frames during your daily outdoor checks prior to children engaging in play. Item #824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Fence height outside of the Juniper classroom beside the gate to the walk area around to the infant outdoor space measured three (3 ) feet six (6) inches. -I suggest adding a fence extender to the top of the fence to give you the required four (4) feet. Item #842 A drug or medicine was administered without written authorization and/or instructions from a child's parent or authorized health professional. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. In the sunflower classroom, one (1) emergency medication on-site without a permission to administer medication form. -I suggest reviewing all medication forms when new medications are brought to the facility to ensure that all the required documents are completed and on-site prior to sending the medication to the assigned classroom. Item #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. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. In the hummingbird classroom, three (3) sunscreen medication forms expired (expiration dates 7/17/2024, 6/29/2024, 7/6/2024), and two (2) sunscreen that expired (4/2022,4/2024). In the dandelion classroom one (1) sunscreen medication form expired 7/19/2024. -I suggest conducting a monthly medication check to ensure that all permission to administer medication forms and medications are valid and in date for the current time frame. Item # 871 Center staff did not comply with the safe sleep policy. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. In the chickadee classroom, while reviewing sleep charts, I observed one (1) sleep chart had not been completed for the child that was in the crib. The staff stated they laid the child down at 12:00p and at 12:25p no visual checks were documented. The staff member completed the chart during the visit. -I suggest setting a timer every fifteen (15) minutes to check. Item #1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment. When submitted, the medical statement shall not be older than 12 months. Staff member employed 6/12/24 had a medical exam on file dated 12/1/22. This medical was completed more than 12 months prior to employment. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item # 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (b) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. Staff member employed 6/12/24 had a TB test on file dated 12/1/22. This TB test was completed more than 12 months prior to employment. Staff member employed 4/26/24 had a TB test dated 6/19/24. Staff member employed 5/3/24 had a TB test dated 6/18/24. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. 0A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers, including the director, uncompensated providers, substitute providers, and volunteers. Item Requirements: Emergency Information Form, including the name, address, and telephone number of the person to be contacted in case of an emergency, and the responsible party's choice of health care professional. Due Date: On or before the first day of work. The emergency information shall be updated as changes occur and at least annually. Staff member hired 6/12/2024 emergency information form was completed on 7/11/24. -I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Item #1041 Prior to employment a Criminal Background Check was not completed. A. Johnson did not have a completed criminal background check. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 First Aid training expired 5/15/24. New First Aid training completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. Staff member hired 2/1/23 CPR training expired 5/15/24. New CPR training was completed 6/9/24. -I recommend that you track CPR/First Aid certifications on a calendar to ensure that all CPR/First Aid trainings remain current. Item #1321 Medical exam or health assessment was not on file before or within 30 days after admission. § 110-91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school-age children of the operator of a child care facility but do apply to the preschool-age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part-time, drop-in, seasonal, after-school or other than a full-time basis. (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt rules which establish minimum sanitation standards for child care centers and their personnel. The sanitation rules adopted by the Commission for Public Health shall cover such matters as the cleanliness of floors, walls, ceilings, storage spaces, utensils, and other facilities; adequacy of ventilation; sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, food protection facilities, bactericidal treatment of eating and drinking utensils, and solid-waste storage and disposal; methods of food preparation and serving; infectious disease control; sleeping facilities; and other items and facilities as are necessary in the interest of the public health. The Commission for Public Health shall allow child care centers to use domestic kitchen equipment, provided appropriate temperature levels for heating, cooling, and storing are maintained. Child care centers that fry foods shall use commercial hoods. These rules shall be developed in consultation with the Department. The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Organizations that provide prepared meals to child care centers only are considered child care centers for purposes of compliance with appropriate sanitation standards. Child enrolled 8/28/23 had a medical exam on file received 3/29/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (2) children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care; Child enrolled 8/23/23 had immunizations on file received 3/29/24. Child enrolled 1/12/24 had immunizations on file dated 3/18/24. Child enrolled 1/6/24 had immunizations on file dated 2/16/24. -I suggest using the children’s file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1757 A valid qualification letter was not on file and available for review at the facility. A. Johnson did not have a qualification letter on file. § 110-90.2. Mandatory child care providers' criminal history checks. (b) Effective January 1, 1996, the Department shall ensure that, prior to employment and every three years thereafter, the criminal history of all child care providers is checked and a determination is made of the child care provider's fitness to have responsibility for the safety and well-being of children based on the criminal history. The Department shall ensure that all child care providers are checked for county, State, and federal criminal histories. (b1) The Department may prevent an individual from being a child care provider if the Department determines that the individual is a habitually excessive user of alcohol, illegally uses narcotic or other impairing drugs, or is mentally or emotionally impaired to an extent that may be injurious to children. Staff member A. Johnson hired 6/3/2024 criminal background check was not completed prior to employment. I reviewed the ABCMS system and the application is in process. - I suggest using the staff file checklist to ensure that all required documents are completed and submitted within the appropriate timeframe. Assisting staff with the online criminal background check process and scheduling their fingerprints with the Sheriff’s department to ensure that this process is completed. Prior to beginning work on the first day ensure staff submit a valid qualifying letter to you. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual's name; (2) the date the center's policy was given and explained to the individual; (3) the individual's signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member's file. Staff member hired 6/12/2024 and a staff member hired 6/17/24 both had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed on 6/24/24. Staff member hired 4/26/24 had The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy verification signed 5/2/24. ** REPEAT VIOLATION** -I suggest using the staff file checklist to ensure that all required documents are submitted within the appropriate timeframe. Item #1867 The depth of the loose surfacing was not based on critical height of the equipment. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (k) The depth of the loose surfacing material shall be based on the critical height of the equipment, which is defined as the maximum height that a child may sit, or stand, as follows: (1) equipment with a critical height of 5 feet or less shall have 6 inches of loose surface materials; (2) equipment with a critical height of more than 5 feet, but less than 7 feet, shall have 6 inches of loose surfacing material, except for sand; (3) equipment with a critical height of 7 feet to 10 feet shall have 9 inches of any of the loose surfacing material, except for sand; and (4) when sand is used as a surfacing material for equipment with a critical height of more than 5 feet, 12 inches shall be required. Mulch depth measured four (4) inches at the base of the gray rock-climbing equipment. The rock-climbing equipment measured six (6) feet five (5) inches. -I suggest having mulch brought in to increase the mulch depth around the gray rock-climbing equipment. Item #1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff member hired 2/20/2024 completed the Recognizing and Responding to Suspicions of Child Maltreatment training on 6/13/24. The Recognizing and Responding to Suspicions of Child Maltreatment training was due by 5/20/2024. -I recommend that you have staff to complete the Recognizing and Responding to Suspicions of Child Maltreatment training within the first two weeks of employment. Item #1898 Staff did not complete the health and safety training within one year of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (a) Child care administrators and staff members shall complete health and safety training within one year of employment, unless the staff member has completed the training within the year prior to beginning employment. Health and safety training shall be in addition to the new staff orientation requirements set forth in Rule .1101 of this Section. The following persons shall be exempt from this requirement: (1) staff members that do not have caregiving responsibilities for a child or group of children; (2) service providers such as speech therapists, occupational therapists, and physical therapists; and (3) substitute providers who provide services for less than 10 days in a 12-month period. Staff member hired 4/3/24 and a staff member hired 6/28/23 have verification of completion of health and safety trainings on file. Staff member hired 9/20/22 completed health and safety trainings 4/7/24. Staff member hired 2/1/23 completed health and safety trainings 5/16/24. -I recommend that you track the due dates for Health and Safety trainings on a calendar to ensure completion within one year of hire. Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/1/ 2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation: Today, we discussed the following: Rated License: We discussed options to renew the Rated License. With the extension of Hold Harmless bill, you do not have to renew the Rated License during this school year unless you choose to. Currently, new QRIS modernization projects is in the works. We discussed what it will look like when the new QRIS system is implemented. Review with staff supervision requirements during naptime and the use of cell phones. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. (b) For groups of children aged two years or older, the staff/child ratio during nap time shall comply with the requirements of this Chapter if at least one person remains in the room, all children are visible to that person, and the total number of required staff are on the premises and within calling distance of the rooms occupied by children. Review with staff role modeling appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements. Iced coffee in a clear cup or coffee mug do not meet the nutritional requirements. Several cups were observed outside sitting on the ground near exterior classroom doors and on carts near exterior doors. However, the children were indoors preparing for lunch and nap when these were observed. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A handwritten visit summary of today’s visit was completed due to time constraints. We the visit summary with you, and signed by me, Karla Terry, Child Care Consultant, Beth Archer, Child Care Consultant, and also signed by Moriah Stegall, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0605 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0609 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1101 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 96 Completed Date: 1/30/2024 Age: From 0 To 5 Total Minutes: 255 Time In: 10:45 AM Time Out: 03:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Moriah Stegall, Administrator, and Kathleen McBride, Administrative Assistant. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Beth Archer, Child Care Consultant, and Jennifer Klutz, Master Teacher, during the visit. Beth Archer, Child Care Consultant, accompanied me today. An electronic signed copy of the visit summary was electronically emailed to you. Your program currently operates with a Five (5) Star Rated License effective 8/22/2022. The permit restrictions were in compliance including daytime care only, children in care on ground level only, meets enhanced ratios, meets enhanced space. Jennifer Klutz, Master Teacher, Kathleen MCBride, Administrative Assistant, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 7/28/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During the observation, I observed the chickadee room group of infant to one year old children engaging in tummy time on the floor and individual bottle feedings. Diaper creams monitored child RH A&D ointment medication form expired 1/17/2024, AC Aquaphor medication forms expired 1/12/2024, and IH Destin medication form. Infant feeding plans were monitored, and child RC feeding plan did not have a parent signature and date. Five (5) plastic wipe packaging’s were observed unlocked under the diaper changer. Dandelions group of infant to two year old children were eating lunch at the tables and the two infants were with a staff member. One (1) infant was begin bottle fed, and one (1) infant was engaged in tummy time on the floor. Diaper creams were monitored child AB Buttpaste medication form expired 1/12/2024. Child MW no medication form on-site for Babyganics sunscreen. One (1) outlet was uncovered and corrected during the visit. Plastic wipe packaging’s were located in the bathroom floor area below five (5) feet, this was corrected during the visit. Sunflowers group of infants to two year old children were finishing up lunch and transitioning to nap time. Three (3) outlets were uncovered on the right of the room. Honeysuckles group of three to five year old children were engaged in naptime. Hummingbirds group of two to five year old children were engaged in naptime. Two (2) outlets were uncovered beside the window. Gross motor room was not being used during the walkthrough. Willows group of three to five year old children were engaged in naptime and non-sleepers were provided a quite activity to do on their cot. Sunscreens were monitored, one (1) expired and one (1) did not have a medication form. Cardinal group of infant to two year old children were engaged in naptime. Diaper creams were monitored child PC Destin medication form expired 1/9/2024. Junipers group of one- to two-year-old children were engaged in naptime. Pine and dogwood rooms are currently closed. Lunch is currently brought from home and two (2) snacks are provided by the facility. The last fire drill was practiced on 10/19/2023. The last emergency drill, lockdown drill, was practiced on 10/27/2023. The last fire inspection was approved on 4/4/2023. The program’s most recent sanitation inspection was completed on 8/31/2023, with fifteen (15) demerits. The Emergency Medical Care Plan is current and posted. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There are five (5) new staff members since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. File concerns three (3) TB test were missing, three (3) medical reports were missing, one (1) shaken baby and abusive head trauma was not completed prior to caring for children, and one (1) first two weeks of orientation was not completed prior to the employees first two weeks of employment. A legal designee was completed for J. Klutz during the visit and updated the floor plan. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In the Chickadee room, there was a feeding plan with no signature or date when received by the center. .0902(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last recorded fire drill was conducted on 10/19/23. .0604(t); .0302(d)(5) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In the Sunflower room, there were 3 uncovered outlets on the right side of the room. In the Hummingbird room there were 2 uncovered outlets beside the window. 10A NCAC 09 .0604(c) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In the Dandylions room, there was no permission form for a bottle of Babyganic Sunscreen. In the Willow room, there was no permission form for a bottle of sunscreen. 10A NCAC 09 .0803(1)(a & b) 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. In the Chickadee room, there was a permission for A and D ointment that expired 1/17/24. There was a permission for Aquaphor expired 1/12/24. There was a permission for Destin that expired 1/1/24. In the Dandylions room, there was a permission form for Buttpaste that expired 1/12/24. In the Cardinal room, there was a permission form for Destin expired 1/9/24. .0803(12) 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 the Chickadee room, there were 5 wipes containers with plastic packaging in an unlocked cabinet under the diaper changing table. In the Sunflower room, trash bags were accessible to children in the cabinet under the diapering sink. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last recorded playground inspection was conducted on 10/12/23. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff member employed 10/16/23 had a medical report on file dated 1/9/24. One staff member employed 1/2/24 had a medical report on file dated 1/4/24. One staff member employed 1/8/24 had no medical report on file. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff member employed 10/16/23 had verification of TB results on file 1/9/24. One staff member employed 11/20/23 had no verification of TB results on file. One staff members employed 1/2/24 had verification of TB results on file 1/4/24. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. One staff member employed 1/2/24 did not have verification of completion of six hours of orientation within the first 2 weeks of employment. .1101(a)(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One staff member employed 10/16/23 had verification of review of the Shaken Baby Abusive Head Trauma policy signed 11/8/23. .0608(d)(1-4) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/13/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item # 805 We discussed that fire drills must be completed monthly and documented as required. You reported that though fire drills are regularly practiced, the information has not been documented. I encouraged you to designate a staff member who will assist in assuming responsibility of the fire drill documentation. 10A NCAC 09 .0604 (t) .0302(d)(5) Item # 859 A playground inspection must be completed by a staff member trained in playground safety at least once per month. I suggest you set a calendar reminder to ensure no playground inspections are missed. 10A NCAC 09 .0605(q) Item # 1032 Staff must have a medical report on file prior to employment that was signed by a health care professional. You reported that the facility gives the forms for a medical report to staff and encourage the return of this information. The facility does not require a medical report to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item # 1033 On or before the first day of work, staff must provide results indicating they were free of active TB and/or TB test or screening was older than 12 months. You reported that the facility gives the form for verification of TB results to staff and encourage the return of this information. The facility does not require TB results to be returned as a condition of employment. 10A NCAC 09 .0701(a) Item 1067 New employees must complete six clock hours of training in the required topic areas during the first two weeks of employment. You reported that this information has been reviewed with the employee but has not be documented. We discussed documenting staff hours during the orientation session to ensure the correct number of hours are recorded. 10A NCAC 09 .1101(a)(b) Item # 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy must be reviewed with new staff prior to providing care for children. A signed acknowledgement with the required information must be maintained in the staff person’s file. 10A NCAC 09 .0609(d)(1-4) The verification for the staff member employed 1/2/24 is now on file. This violation was corrected at visit. Item # 858 In classrooms where children under three years of age are enrolled, plastic bags must be stored out of reach of children and at least five feet from ground level. 10A NCAC 09 .0604(q) Item # 849 Each child with a medication or topical ointment must have signed specific instructions from the child’s parent to administer the medication on file for review. 10A NCAC 09 .0803(1)(b) Item # 849 Medicines, creams or topical ointments must be returned to the parent or discarded after the authorization has expired. If the medication is still being used, a new permission form must be signed. 10A NCAC 09 .0803(12) Item #541 When parents complete the written feeding plan and return it to the facility, a parent signature and the date the facility received the written feeding plan must be listed. Please review forms as parents complete them. 10A NCAC 09 .0902(a) Item #812 Electrical outlets and power strips, not in use, must have safety outlets or safety plugs, unless located behind furniture or equipment that cannot be moved by a child. 10A NCAC 09 .0604 (c ) Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 2 for rated license reassessments. The program’s year of preparation will begin 7/1/2024 and end 6/30/2025. The assessment year will begin 7/1/2025 and end 6/30/2026. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Prescribed medication forms are needed for emergency medication with the required authorization to administer medication and must be updated every six (6) months. - Over the counter and topical medications can be written for up to twelve (12) months. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0302 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0508 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0607 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS110-91 · Violation

Name of Operation: ASU CHILD DEVELOPMENT CENTER Facility ID: 9555061 Consultant: KAITLYN MARSHALL Operation Type: Center Case Number: Visit Date: 7/28/2023 Number Present: 68 Completed Date: 7/28/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaitlyn Marshall, Child Care Consultant and also signed by Moriah Stegall, Administrator, during the visit. An electronic signed copy of the visit summary was emailed to you. Ms. Stegall was present and available to ask and answer questions throughout the visit today. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, medication and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-two percent (92%) as of 7/27/23. The facility is owned by Appalachian State University. Permit type – Five (5) Star issued 8/22/22. Special Services/Restrictions – 1st shift (daytime care), children in care on ground level only, meets enhanced ratios, meets enhanced space. The facility is approved to provide transportation and serves children with special needs. The last annual compliance visit was conducted on 8/17/22. The last fire drill was practiced on 6/28/23. The last shelter-in-place drill was practiced on 6/26/23. The last playground inspection was documented on 6/26/23. The last fire inspection was approved on 4/4/23. The last sanitation inspection was conducted on 11/9/22 with fourteen (14) demerits for a Superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. An incident log was in use and maintained. The Emergency Preparedness and Response plan was last updated 7/14/22. Transportation was not monitored today. The provider stated that they do not provide transportation. We discussed reaching out to your regular consultant to remove the transportation indication from regulatory. There are eighty (80) children enrolled. Eight (8) children’s files were monitored today. There are thirty-four (34) staff. Seven (7) new staff files were monitored today. Staff files were unable to be completed today. I will return for another visit on Monday, 7/31/23 to complete staff files. Violations received during that visit will be added to the original visit summary in our regulatory system. In classroom space 1, children were eating morning snack which consisted of cherries and graham crackers and matched the weekly menu. In classroom space 3, children were observed cleaning up and transitioning to large group story time. In classroom space 4, children were being soothed by caregivers, playing with dinosaur figurines and combining shapes on a magnetic board with magna tiles. Children in classrooms 6 and 7 were engaged in gross motor water play outdoors with sprinklers. Children in classrooms 8, 9, 10 were playing outside, pushing trucks, playing in sand and reading books with caregivers. Interactions were positive and nurturing. Children were actively supervised at all times. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. Classroom spaces 6 and 9 did not have schedules posted. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. The activity plan posted in classroom space 7 was dated 7/17/23-7/21/23. GS 110-91(12); .0508(a) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The fire drill conducted on 6/28/23 was not recorded on the log. .0604(t); .0302(d)(5) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff (hire date 7/17/23) did not have a medical report on file. 10A NCAC 09 .0701(a) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. One (1) child did not have a health assessment on file within 30 days of enrollment. Refer to the Children's Records form for details. GS110-91(1) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The EPR plan was last updated 7/14/22. .0607(e) Technical assistance was provided as follows: Item #415 Note: A schedule must be posted in classroom spaces 10 and 6. G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #428 Note: Plan to post a current activity plan in classroom space 7 G.S. 110-91. Mandatory standards for a license. 12) Developmentally Appropriate Activities. – Each facility shall have developmentally appropriate activities and play materials. The Commission shall establish minimum standards for developmentally appropriate activities for child care facilities. Each child care facility shall have a planned schedule of developmentally appropriate activities displayed in a prominent place for parents to review and the appropriate materials and equipment available to implement the scheduled activities. Each child care center shall make four of the following activity areas available daily: art and other creative play, children's books, blocks and block building, manipulatives, and family living and dramatic play. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Item #805 Note: 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (5) records of monthly fire drills documenting the date and time of each drill, the length of time taken to evacuate the building, and the signature of the person who conducted the drill as required by NC Fire Code 405.5; A copy of the form may be found on the Division's website. Item #1321 Note: The parents of the child indicated on the Children’s Records form must provide a health assessment completed by a health care professional. G.S. 110-91. Mandatory standards for a license. 1) The Commission shall adopt rules for child care facilities to establish minimum requirements for child and staff health assessments and medical care procedures. These rules shall be developed in consultation with the Department. Each child shall have a health assessment before being admitted or within 30 days following admission to a child care facility. The assessment shall be done by: (i) a licensed physician, (ii) the physician's authorized agent who is currently approved by the North Carolina Medical Board, or comparable certifying board in any state contiguous to North Carolina, (iii) a certified nurse practitioner, or (iv) a public health nurse meeting the Departments Standards for Early Periodic Screening, Diagnosis, and Treatment Program. However, no health assessment shall be required of any staff or child who is and has been in normal health when the staff, or the child's parent, guardian, or full-time custodian objects in writing to a health assessment on religious grounds which conform to the teachings and practice of any recognized church or religious denomination. Item #1824 Note: Plan to update the EPR plan to reflect changes that have occurred in the past year. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) The trained staff shall review the Emergency Preparedness and Response Plan annually, or when information in the plan changes, to ensure all information is current. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/11/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaitlyn.marshall@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaitlyn Marshall 2 Pinehurst Ct. Asheville, NC 28805 Please call me at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Lock any hazardous materials that are located in the kitchen in an additional locked storage like a locked cabinet or closet. Hazardous materials are no longer considered to be locked inside a locked kitchen. If a backpack contains only emergency medication, it does not need to be locked. It must be made inaccessible to children by hanging it five (5) feet off of the ground. In classroom space 7, consider re-writing the names on sunscreen. Some of the names are fading. There is broken lattice on the playhouse structure on the hill on the large playground. The lattice is over five (5) feet off the ground but some sharp pieces could fall and pose a hazard to children. Continue to monitor and replace the broken lattice when possible. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaitlyn.marshall@dhhs.nc.gov or 828-713-8192, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times