10A NCAC 09 .0304 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .1102 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 4/30/2026 Number Present: 29 Completed Date: 4/30/2026 Age: From 0 To 4 Total Minutes: 210 Time In: 08:30 AM Time Out: 12:00 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, Sarah Upton, Child Care Consultant and also signed by Alisha Ogle, Administrator, during the visit. A signed copy of the visit summary was electronically sent to you. Ms. Ogle, Administrator, assisted me today with the paperwork and information I needed. Ms. Ogle, was unable to complete the walkthrough of the facility with me due to assisting in classrooms. 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-six percent (86%) as of 4/29/2026. The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of April 30, 2026. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 01, 2025 The last fire drill was practiced on April 09, 2026 The last emergency drill was practiced on April 08, 2026 The last playground inspection was conducted on April 09, 2026. The last fire inspection was conducted on April 22, 2026. The last sanitation inspection was conducted on January 28, 2026 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted current. Lead water testing is showing the following statement: In Progress (Enrollment Completed: 2023-05-11). You have received a new test kit and are planning on completing on Monday. Lead paint and asbestos testing is showing the following statement: Waiting For On-Site Visit Results Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, breakfast, which consisted of peanut butter toast, raisins and milk. This group was also observed outside. Infants and ones were observed during a bottle feeding and free play. The two-through-three-year-old children were observed during free play in centers and preparing for breakfast. The one-through-two-year-old children were observed during morning free play, breakfast, and outside time. 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/ Outdoor area was monitored and met requirements. The program does not provide transportation. All ten (10) staff members’ files were reviewed today. A Staff and Training Worksheet had not be completed prior to the visit and you were not available during the visit to complete it. Five children’s files were monitored during this visit. The following violations were written: Violation Number Comment Rule 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During my walkthrough the laundry room door was unlocked and there was a aerosol can of hairspray, and a bottle of Ajax liquid laundry detergent being stored in the area. In the classroom for children ages two-through-three years of age there was an aerosol can of sunscreen and bug spray being stored underneath the diaper changing table that was not locked. .2820(b) 1041 Prior to employment a Criminal Background Check was not completed. After review of all ten (10) staff members' files it was noted that two (2) staff had not completed their Criminal Background Checks prior to employment. G.S. 110-90.2(b) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of all ten (10) staff member's files it was noted that the administrator's ITS-SIDS training expired on 08/18/2025. .1102(f) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. After review of five (5) children's files it was noted that three (3) children did not have a medical record and immunization records available for review. GS 110-91(1);.0302(d)(2); .0304(g) 1757 A valid qualification letter was not on file and available to review at the facility. After review of all ten (10) staff member's files it was noted that two (2) staff did not have a valid qualification letter on file. G.S. 110-90.2(b) & (d) & .2703(e) Technical Assistance Provided: Item # 1065 you may complete the ITS-SIDS training through Southwestern Child Care Commission. Item #1041 and Item #1757 L. Traxler and T. Nations must complete the Criminal Records Background check immediately. L. Traxler and T. Nations cannot be on-site until they have received their qualification letters. Item #1320 you will need parent to provide copies of the medical statement and the immunizations record if you cannot locate the copies. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by May 14, 2026 Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: Sarah. Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail, Clyde NC 29721 Please call me at 828-782-0937, or email sarah.upton@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: Quality Rating and Improvement System (QRIS): You reported today that you are currently working on getting all of your staff updated in WORKS. You are planning on applying for the Classroom and Instructional Quality pathway once you have everyone in WORKS and their education evaluated. You have already purchased and using FunnyDaffer curriculum. As we discussed today the Desired Result formative assessment listed as an approved formative assessment is currently free. For you to be transitioned to the Classroom and Instructional Pathway, you will need to receive training on the curriculum through FunnyDaffer. You will also need to complete training on the approved formative assessment you choose to use. These training will need to be completed prior to submitting your application. You will need to review and select which items you would like to meet on the Family and Community Engagement Standards form prior to me submitting the information for your transition. Today I reviewed your Facility Continuous Quality Improvement (CQI) Plan. You will need to submit it to me with your application. Consultation: 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 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 sarah.upton@dhhs.nc.gov or 828-782-0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: 1225-128L Visit Date: 2/27/2026 Number Present: 31 Completed Date: 2/27/2026 Age: From 0 To 4 Total Minutes: 165 Time In: 12:15 PM Time Out: 03:00 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 me, Sarah Upton, Child Care Consultant, and Alisha Ogle, Administrator, during the visit. During today’s visit, Ms. Ogle accompanied me during a walk-through of the facility. During the visit, I discussed the information with Ms. Ogle the information she had self-reported. Today I observed the group of children aged one-year-of age with four (4) children present and one (1) staff during nap time and preparing for snack. I observed the group of children ages three-through-five-years of age with eight (8) children and two (2) staff during nap time. I observed the group with three (3) infants, one (1) one-year-old children and one (1) staff during free play on the floor and nap. I observed the group with two-through-three-year-old children with two (2) children napping in the classroom with one (1) staff and eight (8) children playing outside with two (2) staff members. Interactions between children and staff were helpful and encouraging. I spoke with staff regarding times when children did not nap and they reported that children are not required to nap. On days in which children do not nap they are given quite activities to play with on their cots. Limited monitoring of child care requirements was conducted today to include supervision, discipline, nurture, care and treatment of children. There is concern that a child was disciplined for not taking a nap during naptime on November 13, 2025. Based on information obtained through interview with you and review of the video footage for November 13, 2025 the following was determined: On November 13, 2205, you stated that a staff member notified you that she had witnessed another staff member spray a child in the face with a spray bottle. You reported that you promptly reviewed the video footage and confirmed that the employee sprayed liquid from a spray bottle three (3) times in the direction of the child’s face. You indicated that the employee sprayed the child because the child would not take a nap. You further reported that you were uncertain whether the liquid used was a soap and water solution or a disinfectant. When you questioned the employee about which solution had been sprayed, she did not provide an answer. You stated that after reviewing the footage and confirming the incident, you immediately called the staff member into your office and terminated her employment. Today I reviewed the video of the incident above and confirmed that it happened as reported. Based on the self-report, interviews and video footage, the concern regarding discipline is confirmed The following violations were documented during today’s visit: Violation Number Comment Rule 907 Discipline was related to food, rest or toileting. On November 13, 2025 a staff member sprayed at a child's face with a spray cleaning bottle three (3) times for not laying down for rest time. .1803(a)(4-6) Technical assistance was provided as follows: Item #907 as you reported today as soon as you were made aware of the situation on November 13, 2025, and had reviewed the video footage you terminated the staff members employment at your facility immediately on November 13, 2025 probably within 30 minutes of incident. Achieving Compliance: You have already corrected this item by promptly terminating the staff member’s employment at your facility. You do not need to submit a Letter of Compliance at this time. Consultation is provided as follows: I recommend reviewing the facility’s discipline policy with all remaining staff members to ensure they fully understand the policy. I would recommend them signing an acknowledgement statement that you have reviewed this policy with them. 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0302 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/1/2025 Number Present: 38 Completed Date: 5/1/2025 Age: From 0 To 4 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 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, Sarah Upton, Child Care Consultant and also signed by Brenda Stephens, lead teacher in the classroom for children ages zero-through-one year of age. The Administrator, Alisha Ogle, was not present during the visit. An electronic signed copy of the visit summary was left on-site. Today, the indoor areas were monitored, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to inclement weather the outdoor play areas were not monitored but will be monitored at a later date. Because of the limited number of staff and each one needed to met staff to child ratio there was no one available to accompany me during my walk thorough. Staff and training worksheets were not available during my visit and Ms. Ogle was not present. A “other” visit will be conducted on May 06, 2025 to review staff files, children files, programs records and other information that was not gathered today. Please be sure to have the staff and training worksheets completed. The outdoor areas will be monitored on that day as well weather permitting. If this date doesn’t work for you please let me know ASAP. 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. The program’s compliance history was one hundred (100%) percentage as of 04/30/2025 The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of May 01, 2025. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 29, 2024 The last fire drill was practiced on April 11, 2025 The last emergency drill was practiced on April 02, 2025 The last playground inspection will be monitored during your “other” visit. The last fire inspection will be monitored during your “other” visit The last sanitation inspection was conducted on February 27, 2025 with zero (0) demerits for a superior classification. A copy of the inspection will be collected during your “other” visit The Emergency Medical Care plan was posted current. Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, music and movement and preparing for lunch. Infants and ones were observed during nap time, a bottle feeding, free play, and a diaper change. The two-through-three-year-old children were observed during free play in centers and lunch, which consisted of meatballs, pineapples, mashed potatoes, a slice of wheat bread and milk. The one-through-two-year-old children were observed during table toy play and eating lunch. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Today as I entered the classroom for children age zero-through-one-year-old I observed an 11 month child sitting in a highchair drinking a bottle. The two (2) staff members assigned to this classroom were observed with their backs turned toward the child picking up the classroom. At least one (1) staff member was not positioned or sitting near the child so they could see and hear the child eating. As entered the classroom for children age two-through-three-years-old I observed the two (2) staff members putting out child's cots as children were eating at the table and both of their backs were turned to the children. .1801(a)(1-5) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 medical exam was dated 10/04/2024. 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. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 immunization record was dated 10/03/2024. 10A NCAC 09 .0302(d)(2) 1898 Staff did not complete the health and safety training within one year of employment. After review of the staff and training worksheet it was noted that three (3) staff members had not completed all of the health and safety training topics with one year of enrollment as required. .1102(a) Technical assistance was provided as follows: Item #303 during meals and snacks the rule reads that must be staff must be able to see and hear children aged birth to five years old while the children are eating. Because eating is a high-risk activity in that children could become choked, and choking is silent staff need to position themselves in a way that they can see and hear all children eating. When there are two staff members in the classroom, both of them should not be involved in any other activities such as cleaning up or putting out cots while children are eating. These types of chores should wait until the last child has finished or completed by one (1) staff member while the other staff member is supervising children and positioned to see and hear all children still eating. Achieving Compliance: A follow-up visit will be conducted to verify compliance of item #303 supervision. Consultation is provided as follows: Rated License: The “hold harmless” state of rated license reassessments has been extended until the new Quality Rating Improvement System standards are put in place. This means that you will not be required to have a reassessment according to the timelines discussed previously, however you may request one voluntarily. Today I encouraged you to review information about the new standards as it becomes available and to plan on training your staff on the new assessment tools if you are interested in Environment Rating Scales assessments. I will share more information as I am able. Information regarding the QRIS modernization plan can be found on the DCDEE website under the “What’s New” tab. QRIS update: On February 1, 2025, the ECERS-3, ITERS-3, and FCCERS-3 also known as the "3s"— started being used for DCDEE environment rating scale assessments. The DCDEE and the North Carolina Rated License Assessment Project (NCRLAP) have been collaboratively working on the transition to the third edition. Information regarding the transition can be found by visiting https://ncrlap.org/Resources/pages/get-ready-for-3s. These third editions come with a spiral binding at the top, replacing the current revised editions. Visit the NCRLAP’s website, https://ncrlap.org/. for more information about updated resources, credit hour trainings, and outreach assessment opportunities to help you become familiar with these tools. Criminal Background Portal/ABCMS: North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: •See the real-time background check status of staff members. •Run a printable report of the staff roster to assist with compliance visits. •See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. 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. Lead Paint and Asbestos Testing: Child Care Rule .0601(f)- Safe Environments Child Care Rule Effective January 1, 2024 Rule Amendment- This rule was amended to include the specific requirements that child care centers must be free of asbestos hazards. This is in addition to the existing requirement that they be free of lead poisoning hazards. In addition to the updates to this rule, 10A NCAC 41C .1001 through .1007 and 15A NCAC 18A .2816, require all child care facilities (homes and centers) to test for lead in drinking, water, identify lead-based paint hazard, and mitigate or restrict access to identified hazards. The Clean Classrooms for Carolina Kids program is designed to identify and eliminate exposure to lead and asbestos hazards in building infrastructure, while providing child care facilities with the support needed to meet all rule requirements. The program is free, and the first step is to watch one of the pre-enrollment webinars, which are available at www.cleanwaterforUSkids.org/carolina Testing is required to be completed by May 31, 2025. Approved space change: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS Account: 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. Staff Changes: 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. Health and Safety Training: The health and safety trainings are required to be completed within the first year of employment, with the exception of Recognizing and Responding to Suspicions of Child Maltreatment, CPR and First Aid training. These three (3) trainings must be completed within ninety (90) days of employment. Following the initial completion of the health and safety trainings they must be completed within the next five years of employment or prior to expiration (CPR and First Aid). There is a training log available on the Division’s website to document the completion of the trainings. All topics must be covered. You may access health and safety trainings for free on the Division’s website under Moodle. Moodle Support: The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle support. To get help with Moodle, email at DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. Challenging Behaviors Helpline by Healthy Social Behavior Project The Healthy Social Behavior Project is offering technical assistance with challenging behaviors to programs. Please see the link below for more information. I shared the flier with you with information on the Challenging Behaviors Helpline. Website Link: https://www.childcareresourcesinc.org/challenging-behaviors-helpline To speak to a Healthy Social Behavior Specialist, please contact the helpline 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 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0304 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/1/2025 Number Present: 38 Completed Date: 5/1/2025 Age: From 0 To 4 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 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, Sarah Upton, Child Care Consultant and also signed by Brenda Stephens, lead teacher in the classroom for children ages zero-through-one year of age. The Administrator, Alisha Ogle, was not present during the visit. An electronic signed copy of the visit summary was left on-site. Today, the indoor areas were monitored, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to inclement weather the outdoor play areas were not monitored but will be monitored at a later date. Because of the limited number of staff and each one needed to met staff to child ratio there was no one available to accompany me during my walk thorough. Staff and training worksheets were not available during my visit and Ms. Ogle was not present. A “other” visit will be conducted on May 06, 2025 to review staff files, children files, programs records and other information that was not gathered today. Please be sure to have the staff and training worksheets completed. The outdoor areas will be monitored on that day as well weather permitting. If this date doesn’t work for you please let me know ASAP. 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. The program’s compliance history was one hundred (100%) percentage as of 04/30/2025 The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of May 01, 2025. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 29, 2024 The last fire drill was practiced on April 11, 2025 The last emergency drill was practiced on April 02, 2025 The last playground inspection will be monitored during your “other” visit. The last fire inspection will be monitored during your “other” visit The last sanitation inspection was conducted on February 27, 2025 with zero (0) demerits for a superior classification. A copy of the inspection will be collected during your “other” visit The Emergency Medical Care plan was posted current. Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, music and movement and preparing for lunch. Infants and ones were observed during nap time, a bottle feeding, free play, and a diaper change. The two-through-three-year-old children were observed during free play in centers and lunch, which consisted of meatballs, pineapples, mashed potatoes, a slice of wheat bread and milk. The one-through-two-year-old children were observed during table toy play and eating lunch. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Today as I entered the classroom for children age zero-through-one-year-old I observed an 11 month child sitting in a highchair drinking a bottle. The two (2) staff members assigned to this classroom were observed with their backs turned toward the child picking up the classroom. At least one (1) staff member was not positioned or sitting near the child so they could see and hear the child eating. As entered the classroom for children age two-through-three-years-old I observed the two (2) staff members putting out child's cots as children were eating at the table and both of their backs were turned to the children. .1801(a)(1-5) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 medical exam was dated 10/04/2024. 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. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 immunization record was dated 10/03/2024. 10A NCAC 09 .0302(d)(2) 1898 Staff did not complete the health and safety training within one year of employment. After review of the staff and training worksheet it was noted that three (3) staff members had not completed all of the health and safety training topics with one year of enrollment as required. .1102(a) Technical assistance was provided as follows: Item #303 during meals and snacks the rule reads that must be staff must be able to see and hear children aged birth to five years old while the children are eating. Because eating is a high-risk activity in that children could become choked, and choking is silent staff need to position themselves in a way that they can see and hear all children eating. When there are two staff members in the classroom, both of them should not be involved in any other activities such as cleaning up or putting out cots while children are eating. These types of chores should wait until the last child has finished or completed by one (1) staff member while the other staff member is supervising children and positioned to see and hear all children still eating. Achieving Compliance: A follow-up visit will be conducted to verify compliance of item #303 supervision. Consultation is provided as follows: Rated License: The “hold harmless” state of rated license reassessments has been extended until the new Quality Rating Improvement System standards are put in place. This means that you will not be required to have a reassessment according to the timelines discussed previously, however you may request one voluntarily. Today I encouraged you to review information about the new standards as it becomes available and to plan on training your staff on the new assessment tools if you are interested in Environment Rating Scales assessments. I will share more information as I am able. Information regarding the QRIS modernization plan can be found on the DCDEE website under the “What’s New” tab. QRIS update: On February 1, 2025, the ECERS-3, ITERS-3, and FCCERS-3 also known as the "3s"— started being used for DCDEE environment rating scale assessments. The DCDEE and the North Carolina Rated License Assessment Project (NCRLAP) have been collaboratively working on the transition to the third edition. Information regarding the transition can be found by visiting https://ncrlap.org/Resources/pages/get-ready-for-3s. These third editions come with a spiral binding at the top, replacing the current revised editions. Visit the NCRLAP’s website, https://ncrlap.org/. for more information about updated resources, credit hour trainings, and outreach assessment opportunities to help you become familiar with these tools. Criminal Background Portal/ABCMS: North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: •See the real-time background check status of staff members. •Run a printable report of the staff roster to assist with compliance visits. •See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. 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. Lead Paint and Asbestos Testing: Child Care Rule .0601(f)- Safe Environments Child Care Rule Effective January 1, 2024 Rule Amendment- This rule was amended to include the specific requirements that child care centers must be free of asbestos hazards. This is in addition to the existing requirement that they be free of lead poisoning hazards. In addition to the updates to this rule, 10A NCAC 41C .1001 through .1007 and 15A NCAC 18A .2816, require all child care facilities (homes and centers) to test for lead in drinking, water, identify lead-based paint hazard, and mitigate or restrict access to identified hazards. The Clean Classrooms for Carolina Kids program is designed to identify and eliminate exposure to lead and asbestos hazards in building infrastructure, while providing child care facilities with the support needed to meet all rule requirements. The program is free, and the first step is to watch one of the pre-enrollment webinars, which are available at www.cleanwaterforUSkids.org/carolina Testing is required to be completed by May 31, 2025. Approved space change: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS Account: 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. Staff Changes: 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. Health and Safety Training: The health and safety trainings are required to be completed within the first year of employment, with the exception of Recognizing and Responding to Suspicions of Child Maltreatment, CPR and First Aid training. These three (3) trainings must be completed within ninety (90) days of employment. Following the initial completion of the health and safety trainings they must be completed within the next five years of employment or prior to expiration (CPR and First Aid). There is a training log available on the Division’s website to document the completion of the trainings. All topics must be covered. You may access health and safety trainings for free on the Division’s website under Moodle. Moodle Support: The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle support. To get help with Moodle, email at DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. Challenging Behaviors Helpline by Healthy Social Behavior Project The Healthy Social Behavior Project is offering technical assistance with challenging behaviors to programs. Please see the link below for more information. I shared the flier with you with information on the Challenging Behaviors Helpline. Website Link: https://www.childcareresourcesinc.org/challenging-behaviors-helpline To speak to a Healthy Social Behavior Specialist, please contact the helpline 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 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/1/2025 Number Present: 38 Completed Date: 5/1/2025 Age: From 0 To 4 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 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, Sarah Upton, Child Care Consultant and also signed by Brenda Stephens, lead teacher in the classroom for children ages zero-through-one year of age. The Administrator, Alisha Ogle, was not present during the visit. An electronic signed copy of the visit summary was left on-site. Today, the indoor areas were monitored, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to inclement weather the outdoor play areas were not monitored but will be monitored at a later date. Because of the limited number of staff and each one needed to met staff to child ratio there was no one available to accompany me during my walk thorough. Staff and training worksheets were not available during my visit and Ms. Ogle was not present. A “other” visit will be conducted on May 06, 2025 to review staff files, children files, programs records and other information that was not gathered today. Please be sure to have the staff and training worksheets completed. The outdoor areas will be monitored on that day as well weather permitting. If this date doesn’t work for you please let me know ASAP. 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. The program’s compliance history was one hundred (100%) percentage as of 04/30/2025 The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of May 01, 2025. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 29, 2024 The last fire drill was practiced on April 11, 2025 The last emergency drill was practiced on April 02, 2025 The last playground inspection will be monitored during your “other” visit. The last fire inspection will be monitored during your “other” visit The last sanitation inspection was conducted on February 27, 2025 with zero (0) demerits for a superior classification. A copy of the inspection will be collected during your “other” visit The Emergency Medical Care plan was posted current. Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, music and movement and preparing for lunch. Infants and ones were observed during nap time, a bottle feeding, free play, and a diaper change. The two-through-three-year-old children were observed during free play in centers and lunch, which consisted of meatballs, pineapples, mashed potatoes, a slice of wheat bread and milk. The one-through-two-year-old children were observed during table toy play and eating lunch. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Today as I entered the classroom for children age zero-through-one-year-old I observed an 11 month child sitting in a highchair drinking a bottle. The two (2) staff members assigned to this classroom were observed with their backs turned toward the child picking up the classroom. At least one (1) staff member was not positioned or sitting near the child so they could see and hear the child eating. As entered the classroom for children age two-through-three-years-old I observed the two (2) staff members putting out child's cots as children were eating at the table and both of their backs were turned to the children. .1801(a)(1-5) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 medical exam was dated 10/04/2024. 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. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 immunization record was dated 10/03/2024. 10A NCAC 09 .0302(d)(2) 1898 Staff did not complete the health and safety training within one year of employment. After review of the staff and training worksheet it was noted that three (3) staff members had not completed all of the health and safety training topics with one year of enrollment as required. .1102(a) Technical assistance was provided as follows: Item #303 during meals and snacks the rule reads that must be staff must be able to see and hear children aged birth to five years old while the children are eating. Because eating is a high-risk activity in that children could become choked, and choking is silent staff need to position themselves in a way that they can see and hear all children eating. When there are two staff members in the classroom, both of them should not be involved in any other activities such as cleaning up or putting out cots while children are eating. These types of chores should wait until the last child has finished or completed by one (1) staff member while the other staff member is supervising children and positioned to see and hear all children still eating. Achieving Compliance: A follow-up visit will be conducted to verify compliance of item #303 supervision. Consultation is provided as follows: Rated License: The “hold harmless” state of rated license reassessments has been extended until the new Quality Rating Improvement System standards are put in place. This means that you will not be required to have a reassessment according to the timelines discussed previously, however you may request one voluntarily. Today I encouraged you to review information about the new standards as it becomes available and to plan on training your staff on the new assessment tools if you are interested in Environment Rating Scales assessments. I will share more information as I am able. Information regarding the QRIS modernization plan can be found on the DCDEE website under the “What’s New” tab. QRIS update: On February 1, 2025, the ECERS-3, ITERS-3, and FCCERS-3 also known as the "3s"— started being used for DCDEE environment rating scale assessments. The DCDEE and the North Carolina Rated License Assessment Project (NCRLAP) have been collaboratively working on the transition to the third edition. Information regarding the transition can be found by visiting https://ncrlap.org/Resources/pages/get-ready-for-3s. These third editions come with a spiral binding at the top, replacing the current revised editions. Visit the NCRLAP’s website, https://ncrlap.org/. for more information about updated resources, credit hour trainings, and outreach assessment opportunities to help you become familiar with these tools. Criminal Background Portal/ABCMS: North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: •See the real-time background check status of staff members. •Run a printable report of the staff roster to assist with compliance visits. •See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. 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. Lead Paint and Asbestos Testing: Child Care Rule .0601(f)- Safe Environments Child Care Rule Effective January 1, 2024 Rule Amendment- This rule was amended to include the specific requirements that child care centers must be free of asbestos hazards. This is in addition to the existing requirement that they be free of lead poisoning hazards. In addition to the updates to this rule, 10A NCAC 41C .1001 through .1007 and 15A NCAC 18A .2816, require all child care facilities (homes and centers) to test for lead in drinking, water, identify lead-based paint hazard, and mitigate or restrict access to identified hazards. The Clean Classrooms for Carolina Kids program is designed to identify and eliminate exposure to lead and asbestos hazards in building infrastructure, while providing child care facilities with the support needed to meet all rule requirements. The program is free, and the first step is to watch one of the pre-enrollment webinars, which are available at www.cleanwaterforUSkids.org/carolina Testing is required to be completed by May 31, 2025. Approved space change: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS Account: 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. Staff Changes: 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. Health and Safety Training: The health and safety trainings are required to be completed within the first year of employment, with the exception of Recognizing and Responding to Suspicions of Child Maltreatment, CPR and First Aid training. These three (3) trainings must be completed within ninety (90) days of employment. Following the initial completion of the health and safety trainings they must be completed within the next five years of employment or prior to expiration (CPR and First Aid). There is a training log available on the Division’s website to document the completion of the trainings. All topics must be covered. You may access health and safety trainings for free on the Division’s website under Moodle. Moodle Support: The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle support. To get help with Moodle, email at DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. Challenging Behaviors Helpline by Healthy Social Behavior Project The Healthy Social Behavior Project is offering technical assistance with challenging behaviors to programs. Please see the link below for more information. I shared the flier with you with information on the Challenging Behaviors Helpline. Website Link: https://www.childcareresourcesinc.org/challenging-behaviors-helpline To speak to a Healthy Social Behavior Specialist, please contact the helpline 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 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/1/2025 Number Present: 38 Completed Date: 5/1/2025 Age: From 0 To 4 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 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, Sarah Upton, Child Care Consultant and also signed by Brenda Stephens, lead teacher in the classroom for children ages zero-through-one year of age. The Administrator, Alisha Ogle, was not present during the visit. An electronic signed copy of the visit summary was left on-site. Today, the indoor areas were monitored, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to inclement weather the outdoor play areas were not monitored but will be monitored at a later date. Because of the limited number of staff and each one needed to met staff to child ratio there was no one available to accompany me during my walk thorough. Staff and training worksheets were not available during my visit and Ms. Ogle was not present. A “other” visit will be conducted on May 06, 2025 to review staff files, children files, programs records and other information that was not gathered today. Please be sure to have the staff and training worksheets completed. The outdoor areas will be monitored on that day as well weather permitting. If this date doesn’t work for you please let me know ASAP. 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. The program’s compliance history was one hundred (100%) percentage as of 04/30/2025 The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of May 01, 2025. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 29, 2024 The last fire drill was practiced on April 11, 2025 The last emergency drill was practiced on April 02, 2025 The last playground inspection will be monitored during your “other” visit. The last fire inspection will be monitored during your “other” visit The last sanitation inspection was conducted on February 27, 2025 with zero (0) demerits for a superior classification. A copy of the inspection will be collected during your “other” visit The Emergency Medical Care plan was posted current. Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, music and movement and preparing for lunch. Infants and ones were observed during nap time, a bottle feeding, free play, and a diaper change. The two-through-three-year-old children were observed during free play in centers and lunch, which consisted of meatballs, pineapples, mashed potatoes, a slice of wheat bread and milk. The one-through-two-year-old children were observed during table toy play and eating lunch. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Today as I entered the classroom for children age zero-through-one-year-old I observed an 11 month child sitting in a highchair drinking a bottle. The two (2) staff members assigned to this classroom were observed with their backs turned toward the child picking up the classroom. At least one (1) staff member was not positioned or sitting near the child so they could see and hear the child eating. As entered the classroom for children age two-through-three-years-old I observed the two (2) staff members putting out child's cots as children were eating at the table and both of their backs were turned to the children. .1801(a)(1-5) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 medical exam was dated 10/04/2024. 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. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 immunization record was dated 10/03/2024. 10A NCAC 09 .0302(d)(2) 1898 Staff did not complete the health and safety training within one year of employment. After review of the staff and training worksheet it was noted that three (3) staff members had not completed all of the health and safety training topics with one year of enrollment as required. .1102(a) Technical assistance was provided as follows: Item #303 during meals and snacks the rule reads that must be staff must be able to see and hear children aged birth to five years old while the children are eating. Because eating is a high-risk activity in that children could become choked, and choking is silent staff need to position themselves in a way that they can see and hear all children eating. When there are two staff members in the classroom, both of them should not be involved in any other activities such as cleaning up or putting out cots while children are eating. These types of chores should wait until the last child has finished or completed by one (1) staff member while the other staff member is supervising children and positioned to see and hear all children still eating. Achieving Compliance: A follow-up visit will be conducted to verify compliance of item #303 supervision. Consultation is provided as follows: Rated License: The “hold harmless” state of rated license reassessments has been extended until the new Quality Rating Improvement System standards are put in place. This means that you will not be required to have a reassessment according to the timelines discussed previously, however you may request one voluntarily. Today I encouraged you to review information about the new standards as it becomes available and to plan on training your staff on the new assessment tools if you are interested in Environment Rating Scales assessments. I will share more information as I am able. Information regarding the QRIS modernization plan can be found on the DCDEE website under the “What’s New” tab. QRIS update: On February 1, 2025, the ECERS-3, ITERS-3, and FCCERS-3 also known as the "3s"— started being used for DCDEE environment rating scale assessments. The DCDEE and the North Carolina Rated License Assessment Project (NCRLAP) have been collaboratively working on the transition to the third edition. Information regarding the transition can be found by visiting https://ncrlap.org/Resources/pages/get-ready-for-3s. These third editions come with a spiral binding at the top, replacing the current revised editions. Visit the NCRLAP’s website, https://ncrlap.org/. for more information about updated resources, credit hour trainings, and outreach assessment opportunities to help you become familiar with these tools. Criminal Background Portal/ABCMS: North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: •See the real-time background check status of staff members. •Run a printable report of the staff roster to assist with compliance visits. •See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. 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. Lead Paint and Asbestos Testing: Child Care Rule .0601(f)- Safe Environments Child Care Rule Effective January 1, 2024 Rule Amendment- This rule was amended to include the specific requirements that child care centers must be free of asbestos hazards. This is in addition to the existing requirement that they be free of lead poisoning hazards. In addition to the updates to this rule, 10A NCAC 41C .1001 through .1007 and 15A NCAC 18A .2816, require all child care facilities (homes and centers) to test for lead in drinking, water, identify lead-based paint hazard, and mitigate or restrict access to identified hazards. The Clean Classrooms for Carolina Kids program is designed to identify and eliminate exposure to lead and asbestos hazards in building infrastructure, while providing child care facilities with the support needed to meet all rule requirements. The program is free, and the first step is to watch one of the pre-enrollment webinars, which are available at www.cleanwaterforUSkids.org/carolina Testing is required to be completed by May 31, 2025. Approved space change: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS Account: 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. Staff Changes: 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. Health and Safety Training: The health and safety trainings are required to be completed within the first year of employment, with the exception of Recognizing and Responding to Suspicions of Child Maltreatment, CPR and First Aid training. These three (3) trainings must be completed within ninety (90) days of employment. Following the initial completion of the health and safety trainings they must be completed within the next five years of employment or prior to expiration (CPR and First Aid). There is a training log available on the Division’s website to document the completion of the trainings. All topics must be covered. You may access health and safety trainings for free on the Division’s website under Moodle. Moodle Support: The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle support. To get help with Moodle, email at DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. Challenging Behaviors Helpline by Healthy Social Behavior Project The Healthy Social Behavior Project is offering technical assistance with challenging behaviors to programs. Please see the link below for more information. I shared the flier with you with information on the Challenging Behaviors Helpline. Website Link: https://www.childcareresourcesinc.org/challenging-behaviors-helpline To speak to a Healthy Social Behavior Specialist, please contact the helpline 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 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/1/2025 Number Present: 38 Completed Date: 5/1/2025 Age: From 0 To 4 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 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, Sarah Upton, Child Care Consultant and also signed by Brenda Stephens, lead teacher in the classroom for children ages zero-through-one year of age. The Administrator, Alisha Ogle, was not present during the visit. An electronic signed copy of the visit summary was left on-site. Today, the indoor areas were monitored, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to inclement weather the outdoor play areas were not monitored but will be monitored at a later date. Because of the limited number of staff and each one needed to met staff to child ratio there was no one available to accompany me during my walk thorough. Staff and training worksheets were not available during my visit and Ms. Ogle was not present. A “other” visit will be conducted on May 06, 2025 to review staff files, children files, programs records and other information that was not gathered today. Please be sure to have the staff and training worksheets completed. The outdoor areas will be monitored on that day as well weather permitting. If this date doesn’t work for you please let me know ASAP. 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. The program’s compliance history was one hundred (100%) percentage as of 04/30/2025 The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of May 01, 2025. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 29, 2024 The last fire drill was practiced on April 11, 2025 The last emergency drill was practiced on April 02, 2025 The last playground inspection will be monitored during your “other” visit. The last fire inspection will be monitored during your “other” visit The last sanitation inspection was conducted on February 27, 2025 with zero (0) demerits for a superior classification. A copy of the inspection will be collected during your “other” visit The Emergency Medical Care plan was posted current. Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, music and movement and preparing for lunch. Infants and ones were observed during nap time, a bottle feeding, free play, and a diaper change. The two-through-three-year-old children were observed during free play in centers and lunch, which consisted of meatballs, pineapples, mashed potatoes, a slice of wheat bread and milk. The one-through-two-year-old children were observed during table toy play and eating lunch. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Today as I entered the classroom for children age zero-through-one-year-old I observed an 11 month child sitting in a highchair drinking a bottle. The two (2) staff members assigned to this classroom were observed with their backs turned toward the child picking up the classroom. At least one (1) staff member was not positioned or sitting near the child so they could see and hear the child eating. As entered the classroom for children age two-through-three-years-old I observed the two (2) staff members putting out child's cots as children were eating at the table and both of their backs were turned to the children. .1801(a)(1-5) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 medical exam was dated 10/04/2024. 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. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 immunization record was dated 10/03/2024. 10A NCAC 09 .0302(d)(2) 1898 Staff did not complete the health and safety training within one year of employment. After review of the staff and training worksheet it was noted that three (3) staff members had not completed all of the health and safety training topics with one year of enrollment as required. .1102(a) Technical assistance was provided as follows: Item #303 during meals and snacks the rule reads that must be staff must be able to see and hear children aged birth to five years old while the children are eating. Because eating is a high-risk activity in that children could become choked, and choking is silent staff need to position themselves in a way that they can see and hear all children eating. When there are two staff members in the classroom, both of them should not be involved in any other activities such as cleaning up or putting out cots while children are eating. These types of chores should wait until the last child has finished or completed by one (1) staff member while the other staff member is supervising children and positioned to see and hear all children still eating. Achieving Compliance: A follow-up visit will be conducted to verify compliance of item #303 supervision. Consultation is provided as follows: Rated License: The “hold harmless” state of rated license reassessments has been extended until the new Quality Rating Improvement System standards are put in place. This means that you will not be required to have a reassessment according to the timelines discussed previously, however you may request one voluntarily. Today I encouraged you to review information about the new standards as it becomes available and to plan on training your staff on the new assessment tools if you are interested in Environment Rating Scales assessments. I will share more information as I am able. Information regarding the QRIS modernization plan can be found on the DCDEE website under the “What’s New” tab. QRIS update: On February 1, 2025, the ECERS-3, ITERS-3, and FCCERS-3 also known as the "3s"— started being used for DCDEE environment rating scale assessments. The DCDEE and the North Carolina Rated License Assessment Project (NCRLAP) have been collaboratively working on the transition to the third edition. Information regarding the transition can be found by visiting https://ncrlap.org/Resources/pages/get-ready-for-3s. These third editions come with a spiral binding at the top, replacing the current revised editions. Visit the NCRLAP’s website, https://ncrlap.org/. for more information about updated resources, credit hour trainings, and outreach assessment opportunities to help you become familiar with these tools. Criminal Background Portal/ABCMS: North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: •See the real-time background check status of staff members. •Run a printable report of the staff roster to assist with compliance visits. •See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. 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. Lead Paint and Asbestos Testing: Child Care Rule .0601(f)- Safe Environments Child Care Rule Effective January 1, 2024 Rule Amendment- This rule was amended to include the specific requirements that child care centers must be free of asbestos hazards. This is in addition to the existing requirement that they be free of lead poisoning hazards. In addition to the updates to this rule, 10A NCAC 41C .1001 through .1007 and 15A NCAC 18A .2816, require all child care facilities (homes and centers) to test for lead in drinking, water, identify lead-based paint hazard, and mitigate or restrict access to identified hazards. The Clean Classrooms for Carolina Kids program is designed to identify and eliminate exposure to lead and asbestos hazards in building infrastructure, while providing child care facilities with the support needed to meet all rule requirements. The program is free, and the first step is to watch one of the pre-enrollment webinars, which are available at www.cleanwaterforUSkids.org/carolina Testing is required to be completed by May 31, 2025. Approved space change: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS Account: 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. Staff Changes: 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. Health and Safety Training: The health and safety trainings are required to be completed within the first year of employment, with the exception of Recognizing and Responding to Suspicions of Child Maltreatment, CPR and First Aid training. These three (3) trainings must be completed within ninety (90) days of employment. Following the initial completion of the health and safety trainings they must be completed within the next five years of employment or prior to expiration (CPR and First Aid). There is a training log available on the Division’s website to document the completion of the trainings. All topics must be covered. You may access health and safety trainings for free on the Division’s website under Moodle. Moodle Support: The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle support. To get help with Moodle, email at DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. Challenging Behaviors Helpline by Healthy Social Behavior Project The Healthy Social Behavior Project is offering technical assistance with challenging behaviors to programs. Please see the link below for more information. I shared the flier with you with information on the Challenging Behaviors Helpline. Website Link: https://www.childcareresourcesinc.org/challenging-behaviors-helpline To speak to a Healthy Social Behavior Specialist, please contact the helpline 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 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/1/2025 Number Present: 38 Completed Date: 5/1/2025 Age: From 0 To 4 Total Minutes: 180 Time In: 10:30 AM Time Out: 01:30 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, Sarah Upton, Child Care Consultant and also signed by Brenda Stephens, lead teacher in the classroom for children ages zero-through-one year of age. The Administrator, Alisha Ogle, was not present during the visit. An electronic signed copy of the visit summary was left on-site. Today, the indoor areas were monitored, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. Due to inclement weather the outdoor play areas were not monitored but will be monitored at a later date. Because of the limited number of staff and each one needed to met staff to child ratio there was no one available to accompany me during my walk thorough. Staff and training worksheets were not available during my visit and Ms. Ogle was not present. A “other” visit will be conducted on May 06, 2025 to review staff files, children files, programs records and other information that was not gathered today. Please be sure to have the staff and training worksheets completed. The outdoor areas will be monitored on that day as well weather permitting. If this date doesn’t work for you please let me know ASAP. 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. The program’s compliance history was one hundred (100%) percentage as of 04/30/2025 The North Carolina Secretary of State website was viewed prior to today’s visit and Lots-A-Tots, INC, private for-profit corporation, is current/active as of May 01, 2025. Permit type – Three (3) Star License issued on December 01, 2023 Special Services/Restrictions – 1st shift, Meets Enhanced Space The last annual compliance visit was conducted on May 29, 2024 The last fire drill was practiced on April 11, 2025 The last emergency drill was practiced on April 02, 2025 The last playground inspection will be monitored during your “other” visit. The last fire inspection will be monitored during your “other” visit The last sanitation inspection was conducted on February 27, 2025 with zero (0) demerits for a superior classification. A copy of the inspection will be collected during your “other” visit The Emergency Medical Care plan was posted current. Upon arrival I introduced my presence to the staff and explained the reason for my visit. I observed the group with three- to four-year-old children engaged in a group story time, music and movement and preparing for lunch. Infants and ones were observed during nap time, a bottle feeding, free play, and a diaper change. The two-through-three-year-old children were observed during free play in centers and lunch, which consisted of meatballs, pineapples, mashed potatoes, a slice of wheat bread and milk. The one-through-two-year-old children were observed during table toy play and eating lunch. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Today as I entered the classroom for children age zero-through-one-year-old I observed an 11 month child sitting in a highchair drinking a bottle. The two (2) staff members assigned to this classroom were observed with their backs turned toward the child picking up the classroom. At least one (1) staff member was not positioned or sitting near the child so they could see and hear the child eating. As entered the classroom for children age two-through-three-years-old I observed the two (2) staff members putting out child's cots as children were eating at the table and both of their backs were turned to the children. .1801(a)(1-5) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 medical exam was dated 10/04/2024. 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. After review of the five (5) children's files it was noted that one (1) child that was enrolled on 06/03/2024 immunization record was dated 10/03/2024. 10A NCAC 09 .0302(d)(2) 1898 Staff did not complete the health and safety training within one year of employment. After review of the staff and training worksheet it was noted that three (3) staff members had not completed all of the health and safety training topics with one year of enrollment as required. .1102(a) Technical assistance was provided as follows: Item #303 during meals and snacks the rule reads that must be staff must be able to see and hear children aged birth to five years old while the children are eating. Because eating is a high-risk activity in that children could become choked, and choking is silent staff need to position themselves in a way that they can see and hear all children eating. When there are two staff members in the classroom, both of them should not be involved in any other activities such as cleaning up or putting out cots while children are eating. These types of chores should wait until the last child has finished or completed by one (1) staff member while the other staff member is supervising children and positioned to see and hear all children still eating. Achieving Compliance: A follow-up visit will be conducted to verify compliance of item #303 supervision. Consultation is provided as follows: Rated License: The “hold harmless” state of rated license reassessments has been extended until the new Quality Rating Improvement System standards are put in place. This means that you will not be required to have a reassessment according to the timelines discussed previously, however you may request one voluntarily. Today I encouraged you to review information about the new standards as it becomes available and to plan on training your staff on the new assessment tools if you are interested in Environment Rating Scales assessments. I will share more information as I am able. Information regarding the QRIS modernization plan can be found on the DCDEE website under the “What’s New” tab. QRIS update: On February 1, 2025, the ECERS-3, ITERS-3, and FCCERS-3 also known as the "3s"— started being used for DCDEE environment rating scale assessments. The DCDEE and the North Carolina Rated License Assessment Project (NCRLAP) have been collaboratively working on the transition to the third edition. Information regarding the transition can be found by visiting https://ncrlap.org/Resources/pages/get-ready-for-3s. These third editions come with a spiral binding at the top, replacing the current revised editions. Visit the NCRLAP’s website, https://ncrlap.org/. for more information about updated resources, credit hour trainings, and outreach assessment opportunities to help you become familiar with these tools. Criminal Background Portal/ABCMS: North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: •See the real-time background check status of staff members. •Run a printable report of the staff roster to assist with compliance visits. •See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. 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. Lead Paint and Asbestos Testing: Child Care Rule .0601(f)- Safe Environments Child Care Rule Effective January 1, 2024 Rule Amendment- This rule was amended to include the specific requirements that child care centers must be free of asbestos hazards. This is in addition to the existing requirement that they be free of lead poisoning hazards. In addition to the updates to this rule, 10A NCAC 41C .1001 through .1007 and 15A NCAC 18A .2816, require all child care facilities (homes and centers) to test for lead in drinking, water, identify lead-based paint hazard, and mitigate or restrict access to identified hazards. The Clean Classrooms for Carolina Kids program is designed to identify and eliminate exposure to lead and asbestos hazards in building infrastructure, while providing child care facilities with the support needed to meet all rule requirements. The program is free, and the first step is to watch one of the pre-enrollment webinars, which are available at www.cleanwaterforUSkids.org/carolina Testing is required to be completed by May 31, 2025. Approved space change: If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Fire Inspection: Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” Recognizing and Responding to Suspicions of Child Maltreatment training: As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. WORKS Account: 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. Staff Changes: 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. Health and Safety Training: The health and safety trainings are required to be completed within the first year of employment, with the exception of Recognizing and Responding to Suspicions of Child Maltreatment, CPR and First Aid training. These three (3) trainings must be completed within ninety (90) days of employment. Following the initial completion of the health and safety trainings they must be completed within the next five years of employment or prior to expiration (CPR and First Aid). There is a training log available on the Division’s website to document the completion of the trainings. All topics must be covered. You may access health and safety trainings for free on the Division’s website under Moodle. Moodle Support: The Division offers early childhood professionals a wide range of professional development opportunities through our online learning platform Moodle. As we continue expanding our training offerings, DCDEE has established a new email address and phone number for Moodle support. To get help with Moodle, email at DCDEE_Moodle_Support@dhhs.nc.gov or call (919) 814-6326. Challenging Behaviors Helpline by Healthy Social Behavior Project The Healthy Social Behavior Project is offering technical assistance with challenging behaviors to programs. Please see the link below for more information. I shared the flier with you with information on the Challenging Behaviors Helpline. Website Link: https://www.childcareresourcesinc.org/challenging-behaviors-helpline To speak to a Healthy Social Behavior Specialist, please contact the helpline 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 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 sarah.upton@dhhs.nc.gov or 828.782.0937, 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 .0510 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/11/2023 Number Present: 22 Completed Date: 10/11/2023 Age: From 0 To 3 Total Minutes: 105 Time In: 10:30 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 10/5/23 and provide limited monitoring of child care requirements. Alisha Ogle, Administrator/Legal Operator, was on site and available to ask and answer questions. During the Temporary Time Period visit on 10/5/23, twelve (12) violations were cited. Routine care, a small group art activity, outdoor play, and lunch, were observed today. Upon arrival the children in space #4, the classroom with one and two year old children, were making ghost footprints and watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. The violations documented on 10/5/23 were monitored and discussed as follows: Item #415 – A current schedule is posted in space #2, the classroom for school-age children. The afternoon schedule begins at 3:30pm and ends at 5:30m. A half-day schedule is posted for when the school-age children have early dismissal from school. The half-day schedule begins at 11:30am and ends at 5:30pm. The full-day schedule is also posted for when children are out of school and attend the program. The full-day schedule beings at 7:00am and ends at 5:30pm. A written statement was provided on 10/9/23. Item #428 – A activity plan, dated 10/9/23-10/13/23, is posted in space #2, the classroom for school-age children. A written statement was provided on 10/9/23. Items #608 and #609– Lunch was observed in space #4, the classroom with one and two year old children. One (1) teacher washed their hands and helped children wash their hands also. Children washed hands prior to sitting down at the table to eat lunch. A written statement was provided on 10/9/23. Item #705 – There were no protrusions on the sandbox. A written statement was provided on 10/9/23. Item #840 – This was corrected during the visit on 10/5/23. A written statement was provided on 10/9/23. Item #847 – The Coppertone sunscreen in space #4 has been sent home. A written statement was provided on 10/9/23. Item #871 – Blankets used with sleeping infants was corrected during the visit on 10/5/23. A thermometer is located in space #1, the classroom with infants, and read 70 degrees Fahrenheit. A written statement was provided on 10/9/23. Items #1045 and #1067 – The teacher that began employment on 8/14/23 has documentation of completing at least six (6) hours of orientation and a total of more than sixteen (16) hours of orientation. A written statement was provided on 10/9/23. Item #1830 – Spaces #1, #2, and #3 all have trash cans with lids to place biocontaminants. A written statement was provided on 10/9/23. Item #1897 – The teacher that began employment on 6/19/23 completed Recognizing and Responding to Suspicions of Child Maltreatment training on 10/8/23. The certificate of completion is located in the staff file. A written statement was provided on 10/9/23. Staff child/ratio was as follows today: Space #1 had two (2) teachers and six (6) infants and one year old children. Space #2 did not have children in attendance. This is the school-age classroom. Space #3 had two (2) teachers and eight (8) two year through three year old children. Space #4 had two (2) teachers and eight (8) one and two year old children. The following violations of child care requirements was observed: Violation Number Comment Rule 544 Screen time was offered to children under three years of age. Upon arrival the children in space #4, the classroom with one and two year old children, were watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. .0510(f) Technical assistance for correction plan: Screen Time Children under the age of three are prohibited from participating in screen time. 10A NCAC 09 .0510 ACTIVITY AREAS (f) Screen time, including television, videos, video games, and computer usage, shall be prohibited for children under three years of age. 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 10/25/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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 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. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 72%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: It is highly recommended to contact the child care consultant and Child Care Resource and Referral for technical assistance. 10A NCAC 09 .0903 REQUIREMENTS FOR CHILDREN AGED 15 MONTHS AND OLDER Meals and snacks shall be planned according to the number of hours a child is in the center. Children shall be provided a meal or snack a minimum of every four hours. These rules apply in all situations except during sleeping hours and nighttime care: Hours Child Is In Care Age of Child Snack and Meal Requirement Any Hours in Care School-age children 1 snack, unless child is present during the time a meal is being served Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0903 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/11/2023 Number Present: 22 Completed Date: 10/11/2023 Age: From 0 To 3 Total Minutes: 105 Time In: 10:30 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 10/5/23 and provide limited monitoring of child care requirements. Alisha Ogle, Administrator/Legal Operator, was on site and available to ask and answer questions. During the Temporary Time Period visit on 10/5/23, twelve (12) violations were cited. Routine care, a small group art activity, outdoor play, and lunch, were observed today. Upon arrival the children in space #4, the classroom with one and two year old children, were making ghost footprints and watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. The violations documented on 10/5/23 were monitored and discussed as follows: Item #415 – A current schedule is posted in space #2, the classroom for school-age children. The afternoon schedule begins at 3:30pm and ends at 5:30m. A half-day schedule is posted for when the school-age children have early dismissal from school. The half-day schedule begins at 11:30am and ends at 5:30pm. The full-day schedule is also posted for when children are out of school and attend the program. The full-day schedule beings at 7:00am and ends at 5:30pm. A written statement was provided on 10/9/23. Item #428 – A activity plan, dated 10/9/23-10/13/23, is posted in space #2, the classroom for school-age children. A written statement was provided on 10/9/23. Items #608 and #609– Lunch was observed in space #4, the classroom with one and two year old children. One (1) teacher washed their hands and helped children wash their hands also. Children washed hands prior to sitting down at the table to eat lunch. A written statement was provided on 10/9/23. Item #705 – There were no protrusions on the sandbox. A written statement was provided on 10/9/23. Item #840 – This was corrected during the visit on 10/5/23. A written statement was provided on 10/9/23. Item #847 – The Coppertone sunscreen in space #4 has been sent home. A written statement was provided on 10/9/23. Item #871 – Blankets used with sleeping infants was corrected during the visit on 10/5/23. A thermometer is located in space #1, the classroom with infants, and read 70 degrees Fahrenheit. A written statement was provided on 10/9/23. Items #1045 and #1067 – The teacher that began employment on 8/14/23 has documentation of completing at least six (6) hours of orientation and a total of more than sixteen (16) hours of orientation. A written statement was provided on 10/9/23. Item #1830 – Spaces #1, #2, and #3 all have trash cans with lids to place biocontaminants. A written statement was provided on 10/9/23. Item #1897 – The teacher that began employment on 6/19/23 completed Recognizing and Responding to Suspicions of Child Maltreatment training on 10/8/23. The certificate of completion is located in the staff file. A written statement was provided on 10/9/23. Staff child/ratio was as follows today: Space #1 had two (2) teachers and six (6) infants and one year old children. Space #2 did not have children in attendance. This is the school-age classroom. Space #3 had two (2) teachers and eight (8) two year through three year old children. Space #4 had two (2) teachers and eight (8) one and two year old children. The following violations of child care requirements was observed: Violation Number Comment Rule 544 Screen time was offered to children under three years of age. Upon arrival the children in space #4, the classroom with one and two year old children, were watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. .0510(f) Technical assistance for correction plan: Screen Time Children under the age of three are prohibited from participating in screen time. 10A NCAC 09 .0510 ACTIVITY AREAS (f) Screen time, including television, videos, video games, and computer usage, shall be prohibited for children under three years of age. 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 10/25/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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 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. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 72%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: It is highly recommended to contact the child care consultant and Child Care Resource and Referral for technical assistance. 10A NCAC 09 .0903 REQUIREMENTS FOR CHILDREN AGED 15 MONTHS AND OLDER Meals and snacks shall be planned according to the number of hours a child is in the center. Children shall be provided a meal or snack a minimum of every four hours. These rules apply in all situations except during sleeping hours and nighttime care: Hours Child Is In Care Age of Child Snack and Meal Requirement Any Hours in Care School-age children 1 snack, unless child is present during the time a meal is being served Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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 .2215 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/11/2023 Number Present: 22 Completed Date: 10/11/2023 Age: From 0 To 3 Total Minutes: 105 Time In: 10:30 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 10/5/23 and provide limited monitoring of child care requirements. Alisha Ogle, Administrator/Legal Operator, was on site and available to ask and answer questions. During the Temporary Time Period visit on 10/5/23, twelve (12) violations were cited. Routine care, a small group art activity, outdoor play, and lunch, were observed today. Upon arrival the children in space #4, the classroom with one and two year old children, were making ghost footprints and watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. The violations documented on 10/5/23 were monitored and discussed as follows: Item #415 – A current schedule is posted in space #2, the classroom for school-age children. The afternoon schedule begins at 3:30pm and ends at 5:30m. A half-day schedule is posted for when the school-age children have early dismissal from school. The half-day schedule begins at 11:30am and ends at 5:30pm. The full-day schedule is also posted for when children are out of school and attend the program. The full-day schedule beings at 7:00am and ends at 5:30pm. A written statement was provided on 10/9/23. Item #428 – A activity plan, dated 10/9/23-10/13/23, is posted in space #2, the classroom for school-age children. A written statement was provided on 10/9/23. Items #608 and #609– Lunch was observed in space #4, the classroom with one and two year old children. One (1) teacher washed their hands and helped children wash their hands also. Children washed hands prior to sitting down at the table to eat lunch. A written statement was provided on 10/9/23. Item #705 – There were no protrusions on the sandbox. A written statement was provided on 10/9/23. Item #840 – This was corrected during the visit on 10/5/23. A written statement was provided on 10/9/23. Item #847 – The Coppertone sunscreen in space #4 has been sent home. A written statement was provided on 10/9/23. Item #871 – Blankets used with sleeping infants was corrected during the visit on 10/5/23. A thermometer is located in space #1, the classroom with infants, and read 70 degrees Fahrenheit. A written statement was provided on 10/9/23. Items #1045 and #1067 – The teacher that began employment on 8/14/23 has documentation of completing at least six (6) hours of orientation and a total of more than sixteen (16) hours of orientation. A written statement was provided on 10/9/23. Item #1830 – Spaces #1, #2, and #3 all have trash cans with lids to place biocontaminants. A written statement was provided on 10/9/23. Item #1897 – The teacher that began employment on 6/19/23 completed Recognizing and Responding to Suspicions of Child Maltreatment training on 10/8/23. The certificate of completion is located in the staff file. A written statement was provided on 10/9/23. Staff child/ratio was as follows today: Space #1 had two (2) teachers and six (6) infants and one year old children. Space #2 did not have children in attendance. This is the school-age classroom. Space #3 had two (2) teachers and eight (8) two year through three year old children. Space #4 had two (2) teachers and eight (8) one and two year old children. The following violations of child care requirements was observed: Violation Number Comment Rule 544 Screen time was offered to children under three years of age. Upon arrival the children in space #4, the classroom with one and two year old children, were watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. .0510(f) Technical assistance for correction plan: Screen Time Children under the age of three are prohibited from participating in screen time. 10A NCAC 09 .0510 ACTIVITY AREAS (f) Screen time, including television, videos, video games, and computer usage, shall be prohibited for children under three years of age. 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 10/25/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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 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. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 72%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: It is highly recommended to contact the child care consultant and Child Care Resource and Referral for technical assistance. 10A NCAC 09 .0903 REQUIREMENTS FOR CHILDREN AGED 15 MONTHS AND OLDER Meals and snacks shall be planned according to the number of hours a child is in the center. Children shall be provided a meal or snack a minimum of every four hours. These rules apply in all situations except during sleeping hours and nighttime care: Hours Child Is In Care Age of Child Snack and Meal Requirement Any Hours in Care School-age children 1 snack, unless child is present during the time a meal is being served Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/11/2023 Number Present: 22 Completed Date: 10/11/2023 Age: From 0 To 3 Total Minutes: 105 Time In: 10:30 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 10/5/23 and provide limited monitoring of child care requirements. Alisha Ogle, Administrator/Legal Operator, was on site and available to ask and answer questions. During the Temporary Time Period visit on 10/5/23, twelve (12) violations were cited. Routine care, a small group art activity, outdoor play, and lunch, were observed today. Upon arrival the children in space #4, the classroom with one and two year old children, were making ghost footprints and watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. The violations documented on 10/5/23 were monitored and discussed as follows: Item #415 – A current schedule is posted in space #2, the classroom for school-age children. The afternoon schedule begins at 3:30pm and ends at 5:30m. A half-day schedule is posted for when the school-age children have early dismissal from school. The half-day schedule begins at 11:30am and ends at 5:30pm. The full-day schedule is also posted for when children are out of school and attend the program. The full-day schedule beings at 7:00am and ends at 5:30pm. A written statement was provided on 10/9/23. Item #428 – A activity plan, dated 10/9/23-10/13/23, is posted in space #2, the classroom for school-age children. A written statement was provided on 10/9/23. Items #608 and #609– Lunch was observed in space #4, the classroom with one and two year old children. One (1) teacher washed their hands and helped children wash their hands also. Children washed hands prior to sitting down at the table to eat lunch. A written statement was provided on 10/9/23. Item #705 – There were no protrusions on the sandbox. A written statement was provided on 10/9/23. Item #840 – This was corrected during the visit on 10/5/23. A written statement was provided on 10/9/23. Item #847 – The Coppertone sunscreen in space #4 has been sent home. A written statement was provided on 10/9/23. Item #871 – Blankets used with sleeping infants was corrected during the visit on 10/5/23. A thermometer is located in space #1, the classroom with infants, and read 70 degrees Fahrenheit. A written statement was provided on 10/9/23. Items #1045 and #1067 – The teacher that began employment on 8/14/23 has documentation of completing at least six (6) hours of orientation and a total of more than sixteen (16) hours of orientation. A written statement was provided on 10/9/23. Item #1830 – Spaces #1, #2, and #3 all have trash cans with lids to place biocontaminants. A written statement was provided on 10/9/23. Item #1897 – The teacher that began employment on 6/19/23 completed Recognizing and Responding to Suspicions of Child Maltreatment training on 10/8/23. The certificate of completion is located in the staff file. A written statement was provided on 10/9/23. Staff child/ratio was as follows today: Space #1 had two (2) teachers and six (6) infants and one year old children. Space #2 did not have children in attendance. This is the school-age classroom. Space #3 had two (2) teachers and eight (8) two year through three year old children. Space #4 had two (2) teachers and eight (8) one and two year old children. The following violations of child care requirements was observed: Violation Number Comment Rule 544 Screen time was offered to children under three years of age. Upon arrival the children in space #4, the classroom with one and two year old children, were watching a children’s show with Donald Duck on a laptop with a Bluetooth speaker. .0510(f) Technical assistance for correction plan: Screen Time Children under the age of three are prohibited from participating in screen time. 10A NCAC 09 .0510 ACTIVITY AREAS (f) Screen time, including television, videos, video games, and computer usage, shall be prohibited for children under three years of age. 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 10/25/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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 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. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 72%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: It is highly recommended to contact the child care consultant and Child Care Resource and Referral for technical assistance. 10A NCAC 09 .0903 REQUIREMENTS FOR CHILDREN AGED 15 MONTHS AND OLDER Meals and snacks shall be planned according to the number of hours a child is in the center. Children shall be provided a meal or snack a minimum of every four hours. These rules apply in all situations except during sleeping hours and nighttime care: Hours Child Is In Care Age of Child Snack and Meal Requirement Any Hours in Care School-age children 1 snack, unless child is present during the time a meal is being served Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0304 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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 .2215 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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 .2802 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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 .2809 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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. 110-86 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/5/2023 Number Present: 22 Completed Date: 10/5/2023 Age: From 0 To 4 Total Minutes: 240 Time In: 10:15 AM Time Out: 02:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Sarah Upton, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 9/22/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 10/5/23. The monthly playground inspection must be completed in October 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. The Emergency Preparedness Response (EPR) plan was due to be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced in October 2023. The EPR plan has been printed and is maintained in the office. The emergency medical care (EMC) plan was posted and current. The incident log was located in the office and the last documented incident report was from 8/31/23. The children were observed during outdoor play, free play, lunch, and nap. The one and two year old children on the playground had room for gross motor activities. The teachers with the infant and one year old children were providing routine caregiving. One teacher was on the floor with the children and attentive to their needs. The children, ages two through four years, were eating lunch; macaroni and cheese, corn, apples, and milk as stated on the menu. There are is one (1) new staff and the staff file was reviewed. Ms. Ogle would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the 2024-25 prep year. Plan to visit the ncrlap.org website for additional information, webinars, and resources. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with applicable child care requirements pertinent to this facility. The following violations of child care requirements were observed: Violation Number Comment Rule 415 A current schedule was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current schedule posted that reflected the actual time children are in care. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. In space 2 that is currently being used for school aged children there was not a current activity plan posted. The last posted plan was dated September 18-22. GS 110-91(12); .0508(a) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space four (4) which is currently being used to care for children ages one through two years of age children were not observed washing their hands before lunch. In space three (3) which is currently being used for children ages two through four children were not observed washing their hands after lunch. 15A NCAC 18A .2803(c) 609 Staff did not wash their hands thoroughly before beginning work, before/after handling food, before bottle feeding or serving to other children, after toileting or handling body fluids, after diaper changing and after handling soiled items. Teachers in space three (3) were not observed washing their hands before lunch. 15A NCAC 18A .2803(a) 705 Equipment and furnishings were not sturdy, stable and free of hazards. There were two (2) screws on the sandbox that are raised causing protrusions. .0601(c) 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. In space four (4) where children ages one-through-two years of age are currently being cared for there were several batteries and a bottle of liquid white-out being stored on a shelf in a clear container instead of being stored in a locked cabinet or closet. .2820(b) 847 Parent's medication authorization did not include required information. In space four (4) which is currently being used to care for children ages one-through-two years of age there was a contained of sunscreen labeled with a child's name but there was no written authorization form to accompany the sunscreen. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. In space one (1) that is currently being used to care for children ages zero months through one year of age, two (2) children under one year of age were observed laying on cots covered with blankets. Additionally, there was no thermometer in the classroom to ensure the temperature stayed between 68-75 degrees. 10A NCAC 09 .0606(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff with a hire date of 8/14/23 did not have documentation of receiving at least 16 hours of new staff orientation. .1101(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 (1) staff with a hire date of 8/14/23 did not have documentation of receiving six hours of new staff orientation in required topic area. .1101(a)(b) 1830 Potential biocontaminants were not stored properly (locked storage, removed from premises, inaccessible to children, or covered plastic lined receptacle). Spaces #1, #2, and #3 have plastic lined receptacles without a cover for biocontaminants. .0604(v) 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. One (1) staff with a hire date of 6/19/23, does not have the training certificate on file that has their name or date listed on the certificate. .1102(g) Technical assistance for correction plan: **New Staff Orientation The staff hired on 8/14/23 must complete and have documentation of the required new staff orientation. 10A NCAC 09 .1101 NEW STAFF ORIENTATION REQUIREMENTS (a) Each center shall ensure that each new employee who is expected to have contact with children receives 16 hours of on-site orientation within the first six weeks of employment. As part of this orientation, each new employee shall complete six hours of orientation within the first two weeks of employment. *Storage of Biocontaminents A trash can with a lid must be in space #1, #2, and #3. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (v) In child care centers, biocontaminants shall be: (1) stored in locked areas; (2) removed from the premises; (3) inaccessible to children; or (4) shall be disposed of in a covered, plastic lined receptacle. 10A NCAC 09 .0102 DEFINITIONS The terms and phrases used in this Chapter are defined as follows except when the context of the rule requires a different meaning. The definitions prescribed in G.S. 110-86 also apply to these Rules. (5) "Biocontaminant" means blood, bodily fluids, or excretions that may spread infectious disease. *Safe Outdoor Environment The two (2) screws at the sandbox causing protrusions must be removed or screwed down further to not stick up. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (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. *Recognizing and Responding to Suspicions of Child Maltreatment Training The one (1) staff must have the training certificate on file with their name and date documented on the certificate. 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. **Activity Schedules and Plans All age groups must have current schedule and activity posted for reference by parents and caregivers/ 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. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. *Storage of Hazardous Items Corrosive agents such as batteries must be stored in a locked cabinet or closest. Items with more than one warning must also be stored in a locked cabinet or closet. 15A NCAC 18A .2820 STORAGE (b) Toxic substances, which include 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 shall be kept in the original container or in another labeled container, used according to the manufacturer's instructions, and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination lock, electronic or magnetic device, keypad, key, or equivalent locking device. Keys and electronic or magnetic unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any other product that is labeled "keep out of reach of children" and does not have any other warnings on the label shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. For the purpose of Paragraphs (b), (c), and (d) of this Rule, a product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor *Medication Authorization Form Requirements The medication authorization forms must accompany any medication through the duration of the medication. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Safe Sleep Policy The safe sleep policy needs to be followed at all times. As we talked about today the same safe sleep policy applies to children 13 months and younger that are transitioning to cots/mats. 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: (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; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; *Handwashing All children must wash their hands before and after eating. All teachers need to wash their hands before serving or assisting children with meals and snacks. **I recommend you contact Meagan Cagle, Child Care Health Consultant and request a training on children and staff handwashing requirements. According to 15A NCAC 18A .2803 HANDWASHING (a) Child care center employees shall wash their hands as follows when at work in a child care center: (1) upon reporting for work at the child care center: (2) before and after handling or preparing food; (3) before bottle feeding a child; (4) before providing food service; (5) before handling clean utensils; (6) after toileting or handling of body fluids, including but not limited to saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, and pustulant discharge; (7) after diaper changing; (8) after handling soiled items that are not clean; (9) after being outdoors; (10) after handling animals or animal cages; and (11) after removing disposable gloves. (b) The use of a hand antiseptic does not replace the requirements for handwashing in Paragraph (a) of this Rule except that an employee who is supervising a child or children outdoors may use a hand antiseptic while outdoors in lieu of handwashing, provided that the employee's hands are washed in accordance with Paragraph (e) of this Rule when the employee returns indoors. Hand antiseptic shall not be used in lieu of handwashing when the employee's action that necessitates handwashing is diapering, food preparation, or food service. (c) Child care center employees shall ensure that children wash their hands as follows: (1) upon arrival at the child care center; (2) after each diaper change or visit to the toilet; (3) before eating meals or snacks; (4) before and after water play; (5) after being outdoors; and (6) after handling animals or animal cages 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 10/19/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 74%. The compliance history after the visit will be reviewed to determine if the facility will be able to transition to a star-rated license or be recommended for an administrative action. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; If a star-rated license can be issued, then the following information will be used to determine the rated license points. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the four (4) points for staff education based on the previous ownership. Program Standards: The facility will use the two (2) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is required to meet enhanced space and reduced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. 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. 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. Consultation: An unannounced follow-up visit may be made to the facility to verify compliance. We discussed the annual fire inspection is due on or before 7/31/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 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. We discussed playground space #2 is not being used until further notice due to repairs. Playground space #1 is shared and different playground times are documented on each classroom schedule. During a future visit, it may be requested by the child care consultant to observe a fire drill, shelter-in-place drill, or lockdown drill. We discussed the child care sanitation requirements below: 15A NCAC 18A .2815 WATER SUPPLY (e) Hot water used for cleaning and sanitizing utensils and laundry shall be provided at a minimum temperature of 120 degrees Fahrenheit at the point of use. Water in areas accessible to children shall be tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit. Hot water that exceeds 120 degrees Fahrenheit is a burn hazard and shall not be provided in areas accessible to children. For handwash lavatories used exclusively by school-age children, the requirement to provide water tempered between 80 degrees Fahrenheit and 110 degrees Fahrenheit shall not apply. In the event of the loss of hot water at the child care center, the operator shall immediately notify the local health department that serves the county in which the child care center is located. 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (f) Linens shall be kept clean, in good repair, and stored with the mat or cot that the linens are assigned to or stored apart from the mattress or cot in a manner that keeps the linens used for each child separate from the linens belonging to other children. Linens shall be laundered between users, when soiled, and otherwise once per week. Linens used in rooms where the children in care are less than 12 months old shall be changed and laundered when soiled and otherwise at least daily. Linens shall be large enough to cover the bed, cot, or mat's sleeping surface. Sarah Upton is assigned as your child care consultant. You may reach Ms. Upton at sarah.upton@dhhs.nc.gov or 828.782.0937. 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 the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0302 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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 .0510 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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. 110-86 · Violation

Name of Operation: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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: LOTS-A-TOTS Facility ID: 87000084 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 8/9/2023 Number Present: 34 Completed Date: 8/9/2023 Age: From 0 To 10 Total Minutes: 260 Time In: 09:40 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to monitor compliance with all applicable child care requirements during the second temporary time period visit. The facility is on a temporary license due to a change of ownership. Kaitlyn Marshall, Child Care Consultant, accompanied me on the visit. Alisha Ogle, Administrator/Legal Operator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Alisha Ogle, during the visit. An electronic signed copy of the visit summary was electronically emailed to Alisha Ogle. Currently this center operates with a Temporary License, issued 6/1/23 and is effective through 12/1/23. The restrictions include daytime care only; meets enhanced space; maximum capacity forty-nine (49) children; and age range; 0-12 years. The Secretary of State website was reviewed today, and the corporation, Lots-A-Tots, Inc., is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was practiced on 7/21/23. A monthly playground inspection must be completed once at least one (1) staff has completed playground safety training. Ms. Ogle is scheduled to take playground safety training on 8/15/23. The monthly playground inspection must be completed in August 2023. The last sanitation inspection was conducted on 7/19/23 with zero (0) demerits for a Superior rating. An approved fire inspection was completed 7/31/23. An approved building inspection was completed on 7/12/23. A zoning letter for the facility has been received and is dated 5/11/23. Alisha Ogle completed the two-day pre-licensing workshop on 7/26/23. The administrative, operational, and personnel policies have been submitted for review and meet the required topics. The Emergency Preparedness Response (EPR) plan must be completed on or before 10/1/23. Ms. Ogle completed EPR training on 5/22/17. A shelter-in-place drill and lockdown drill must be practiced once the EPR plan is completed. The emergency medical care (EMC) plan was posted and current. The incident log was in use and maintained. The children were observed playing outdoors, having free play in the classrooms, routine care, lunch, and nap. The lunch today was spaghetti with meat sauce, oranges, peas, and milk. Three (3) children files were monitored. There are eleven (11) staff. Seven (7) staff files were monitored. One (1) volunteer file was monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s three-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 12/1/23. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. 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 of child care requirements were observed: Violation Number Comment Rule 431 The activity plan did not provide at least 4 different activities daily listed in GS 110-91(12): art/creative play; books; blocks; manipulatives; and family living and dramatic play, including one of which is outdoors if weather conditions permit. The activity plan in space #2, the classroom with two year olds through four year olds, did not provide at least four (4) different activities daily including an outdoor activity. .0508(g)(2) 445 For children under three years of age, developmentally appropriate toys and activities were not provided as outlined in Rule. Dolls were not provided or accessible for children in space #1, the classroom with infants and one year olds. .0510 (e ) (1)(A-G) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator in the kitchen did not have a thermometer to indicate the temperature. 15A NCAC 18A .2806(j)(2) 721 All equipment and furnishings were not in good repair. Outdoor space #1 had a plastic, rocking see saw that was missing a handle. Outdoor space #1 had a battery operated activity chair with desk that did not work and had mildew on the surface. Outdoor space #1 had a plastic sand sifter that was broken. G.S. 110-91(6); .0601(b) 847 Parent's medication authorization did not include required information. In space #1, there was one (1) diaper cream medication authorization was missing parent signature, date signed, manner in which the ointment shall be applied, amount of dosage, and frequency of dosage. In space #2, there were one (1) sunscreen medication authorization and one (1) bug spray medication authorization that were missing the parent signature, date signed, and manner in which it should be applied. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #1, there was one (1) diaper cream that expired 12/2022. In space #2, there was one (1) sunscreen that expired 11/2022, one (1) diaper cream that expired on 10/2021, and one (1) diaper cream that expired 2/2023. In space #4, one (1) diaper cream expired 12/2022, one sunscreen expired 1/2023, and one (1) sunscreen expired 3/2023. In space #2, there was one (1) medication authorization for diaper cream expired 4/6/23 and one (1) medication authorization expired for sunscreen 10/9/22. In space #4, there was one (1) sunscreen medication authorization expired 5/4/23, one (1) bug spray medication authorization expired 6/30/23, one (1) diaper cream medication authorization expired on 5/4/23, and two (2) bug spray medication authorizations expired on 5/2/23. .0803(12) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff hired on 5/1/23 did not have specific wording to state the staff was physically an emotionally fit to care for children. Refer to the staff and training worksheets. 10A NCAC 09 .0701(a) 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. One (1) child with an enrollment date of 6/1/23 did not have immunizations on file. Refer to the children record worksheet. 10A NCAC 09 .0302(d)(2) 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 (1) staff hired on 5/1/23 had cared for children prior to having the signed acknowledgement dated 6/2/23 on file. .0608(d)(1-4) Technical assistance for correction plan: *Medication Authorization Form Requirements The medication authorization forms must be completed in their entirety. All medications authorization and medications that are received by the facility must be reviewed by staff to be sure all information is accurate and complete. It recommended to audit all medication authorizations periodically to ensure they are completed. *Expired Medications and Medication Authorization All expired medications must be returned to the parent or discarded. Today during the visit, all expired medications were discarded. All expired medication authorizations must be renewed or the topical diaper cream or sunscreen must be sent home with the parent, or discarded. We discussed to look at the expiration dates of the medications prior to accepting them at the facility. It is recommended to audit all medications periodically to be sure none are expired. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. (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. *Prevention of Shaken Baby and Abusive Head Trauma Acknowledgement A plan must be put in place to state how the policy will be reviewed with staff prior to caring for children and how the signed acknowledgement will be on file prior to caring for children. 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. *Staff Medical Report The staff must have a statement signed by a health care professional that indicates the staff is physically and emotionally fit to care for children. 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. *Immunizations The immunization record for the child must be on file. It is recommended to audit child files to be sure all immunizations are on file. 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; *Equipment and Materials in Poor Repair - Corrected During the Visit The equipment and materials in poor repair must be made inaccessible to children and/or removed from the premises. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. *Activity Plans Each day of the activity plan must include at least four (4) different activities and an outdoor activity. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. *Age Appropriate Toys for Children Under Three Years of Age Dolls must be added to space #1, in the classroom with infants and one year old children. 10A NCAC 09 .0510 ACTIVITY AREAS (e) When children under three years old are in care the following apply: (1) each center shall have developmentally appropriate toys and activities for each child to promote the child’s emotional and social development, health and physical development, approaches to play and learning, language development, and communication and cognitive development, including: (A) books; (B) blocks; (C) dolls; (D) pretend play materials; (E) musical toys; (F) sensory toys; and (G) fine motor toys; *Thermometer for Refrigerator A thermometer must be purchased and placed in the kitchen refrigerator to indicate a temperature of 45 degrees F or less. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (d) Bulk food stored in a refrigerator shall be stored at 45 degrees Fahrenheit or below and stored in the child care center's kitchen or in an approved food preparation area equipped with a full-size refrigerator. Specialty bulk milk that is sent from home for consumption by a child while at the child care center may be stored as set forth in this Paragraph when the child's parent or guardian provides written permission and the specialty bulk milk is sent to the child care center at the beginning of each week unopened, labeled with the date received by the child care center, and labeled with the name of the child to whom the bulk specialty milk belongs. Any remaining bulk specialty milk shall be sent home at the end of the week with the child to whom the bulk specialty milk belongs. 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 8/23/23. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@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. Rated License Assessment Consultation: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history score for the facility prior to the visit today was 65%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied 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. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four-year-old children. A curriculum is not implemented at this facility. Consultation: It is recommended to store the wooden blocks outdoors in covered storage, when not in use, to keep in good repair. We discussed that activity plans must include the date to show they are current. 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. We discussed the following child care rule applies for outdoor safety. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (c) Separate play areas or time schedules shall be provided for children under two years of age unless fewer than 15 children of any age are in care. We discussed on-going annual training starts at the staff member’s one (1) year employment date. On-going training timelines are specific to each staff member’s employment date. There are infants between ten months and eleven months of age that are sleeping on cots. It is recommended to update your safe sleep policy to make parents aware when their infant transitions from a crib to a cot. We also discussed to look at the manufacturer instructions to be sure the cots are age appropriate for infants. We discussed that the child care rule below applies to children two years old or older. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (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. Reminder – CPR/First Aid training is due for staff within ninety (90) days of employment. 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 approved training organization list and approved courses can be located on the Division’s website. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The approved training organization list and approved courses can be located on the Division’s website. Reminder – Playground safety training is due for one (1) staff within six (6) months from the date of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (e) One staff member shall complete training in playground safety. This training shall address playground safety hazards, playground supervision, maintenance and general upkeep of the outdoor learning environment, and age and developmentally appropriate playground materials and equipment. Distance learning shall not be permitted for playground safety training. Completion of playground safety training shall be included in the number of hours needed to meet annual on-going training requirements in this Section. Staff counted to comply with this Rule shall have six months from the date of employment, or from the date a vacancy occurs, to complete the required safety training. A certificate of each designated staff member's completion of this course shall be maintained in the staff member's file in the center. Reminder – Recognizing and Responding to Suspicions of Child Maltreatment training is due for all staff within ninety (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. Reminder that ITS-SIDS training must be completed within two (2) months for any staff with caregiving responsibilities in the infant classroom. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (f) In centers that are licensed to care for infants, the child care administrator and any child care provider scheduled to work in the infant room shall complete ITS-SIDS training. ITS-SIDS training shall be completed within two months of an individual assuming responsibilities in the infant room and every three years thereafter. Child care administrators, as defined in G.S. 110-86(2a), shall complete ITS-SIDS training within 90 days of employment and every three years thereafter. Completion of ITS-SIDS training shall be included once every three years in the number of hours needed to meet on-going training requirements in this Section. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. We discussed to file all incident reports in each child's file after recording on the incident log. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any 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 as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. 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. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis 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