G.S. 110-90 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 8/28/2025 Number Present: 41 Completed Date: 8/28/2025 Age: From 0 To 5 Total Minutes: 240 Time In: 12:30 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor for compliance with applicable child care requirements during a Routine Unannounced Visit. Ms. Betsy Davis greeted me at the front door and escorted me inside. The child care item listing dated April 2025 was used to identify and determine non-compliance. The following sections were monitored for compliance: A1, B1, C4, C5, C6, E1, E2, F3, G1, G3, G4 and G5. A walk through of spaces #1-6, kitchen and outdoor learning environments were monitored for compliance. Children were observed engaged in free play, tummy time and diapering routines. There were metal pegs protruding upward in the outdoor plastic black borders. The pegs protruding should be hammered down with a mallet. Chipped paint was observed on the black outdoor fencing. It was recommended to spray paint the chipped paint. We discussed the ABCMS portal and the required process. A roster report was run prior to the visit. The roster report listed was not accurate and did not have current staff linked to the facility in the ABCMS. Ms. Davis will have two weeks to comply with the child care requirement. Ms. Davis stated she had not completed the training in the Moodle system. The previous administrator, now on medical leave, began the process but did not finalize the process prior to leaving. Contact information for another center staff who could help provide support to Ms. Davis with this process was provided. The process must be completed and maintained as new staff are hired and as staff are terminated. Monthly outdoor inspections, incident log, monthly fire drills and quarterly safety drills were monitored. The center’s printed EPR plan and Ready to Go File were monitored current. The staff and training worksheets were not updated since the last annual compliance visit completed February 10, 2025. The previous staff and training worksheets on file were reviewed were monitored for compliance. Current health questionnaires, CBC qualifications and Child Maltreatment Training were monitored in compliance with the existing staff. One existing staff member, ITS-SIDS training expired. She may not be left alone in the infant room until compliant. The following new staff hires staff files were monitored for compliance: F. Bennett, A. Fernandez, F. Bell, S. Burroughs, E. Medina and A. Jones. The staff and training worksheets will need to be updated and emailed to the consultant. One new staff member presented BLS Provider for CPR from the American Heart Association. There were not any additional modules listed, and credit could not be given. The new staff member has 90 days from their date of hire to comply with CPR and FA training. Ms. Davis was reminded; the only source of verification accepted for CPR and FA is the issued card. The last sanitation inspection was completed July 22, 2025, with seven (7) demerits cited and a Superior classification issued. The last annual fire inspection was completed on September 24, 2024. The visit summary could not be finalized due to technical connectivity issues. A final summary will be emailed to you for your records. The following violations were reviewed with you prior to the end of the visit: #1065-an infant teacher’s ITS-SIDS expired. 1805-No current staff were linked to the facility in the ABCMS. 721-Metal pegs were monitored protruding upwards over the black plastic border outdoors and fencing around HVAC systems were monitored with chipped paint. Violation Number Comment Rule 721 All equipment and furnishings were not in good repair. Metal pegs were monitored protruding upwards over the black plastic border outdoors and fencing around HVAC systems were monitored with chipped paint. G.S. 110-91(6); .0601(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. One existing caregiver's ITS-SIDS training certification expired April 26, 2025. .1102(f) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. Only two existing staff were linked in the ABCMS. There were eight former staff linked that need to be unlinked from the facility in the system. G.S. 110-90.2 & .2703(r) Technical Assistance and General Discussion: 1. It was recommended to purchase the third edition of the ERS. It was also recommended to review all available resources at the NCRLAP website. www.NCLRAP.org, including self-study for centers. It was recommended to participate in the DCDEE webinar related to QRIS and sign up for the provider meetings scheduled for September at CCRI. 2. As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on 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. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, September 11, 2025. You may email me with your letter of correction. Mail written documentation to Mara Brinton, 3687 Stallings Road, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: ratio. Open / not marked corrected.

G.S. 110-91 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 8/28/2025 Number Present: 41 Completed Date: 8/28/2025 Age: From 0 To 5 Total Minutes: 240 Time In: 12:30 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor for compliance with applicable child care requirements during a Routine Unannounced Visit. Ms. Betsy Davis greeted me at the front door and escorted me inside. The child care item listing dated April 2025 was used to identify and determine non-compliance. The following sections were monitored for compliance: A1, B1, C4, C5, C6, E1, E2, F3, G1, G3, G4 and G5. A walk through of spaces #1-6, kitchen and outdoor learning environments were monitored for compliance. Children were observed engaged in free play, tummy time and diapering routines. There were metal pegs protruding upward in the outdoor plastic black borders. The pegs protruding should be hammered down with a mallet. Chipped paint was observed on the black outdoor fencing. It was recommended to spray paint the chipped paint. We discussed the ABCMS portal and the required process. A roster report was run prior to the visit. The roster report listed was not accurate and did not have current staff linked to the facility in the ABCMS. Ms. Davis will have two weeks to comply with the child care requirement. Ms. Davis stated she had not completed the training in the Moodle system. The previous administrator, now on medical leave, began the process but did not finalize the process prior to leaving. Contact information for another center staff who could help provide support to Ms. Davis with this process was provided. The process must be completed and maintained as new staff are hired and as staff are terminated. Monthly outdoor inspections, incident log, monthly fire drills and quarterly safety drills were monitored. The center’s printed EPR plan and Ready to Go File were monitored current. The staff and training worksheets were not updated since the last annual compliance visit completed February 10, 2025. The previous staff and training worksheets on file were reviewed were monitored for compliance. Current health questionnaires, CBC qualifications and Child Maltreatment Training were monitored in compliance with the existing staff. One existing staff member, ITS-SIDS training expired. She may not be left alone in the infant room until compliant. The following new staff hires staff files were monitored for compliance: F. Bennett, A. Fernandez, F. Bell, S. Burroughs, E. Medina and A. Jones. The staff and training worksheets will need to be updated and emailed to the consultant. One new staff member presented BLS Provider for CPR from the American Heart Association. There were not any additional modules listed, and credit could not be given. The new staff member has 90 days from their date of hire to comply with CPR and FA training. Ms. Davis was reminded; the only source of verification accepted for CPR and FA is the issued card. The last sanitation inspection was completed July 22, 2025, with seven (7) demerits cited and a Superior classification issued. The last annual fire inspection was completed on September 24, 2024. The visit summary could not be finalized due to technical connectivity issues. A final summary will be emailed to you for your records. The following violations were reviewed with you prior to the end of the visit: #1065-an infant teacher’s ITS-SIDS expired. 1805-No current staff were linked to the facility in the ABCMS. 721-Metal pegs were monitored protruding upwards over the black plastic border outdoors and fencing around HVAC systems were monitored with chipped paint. Violation Number Comment Rule 721 All equipment and furnishings were not in good repair. Metal pegs were monitored protruding upwards over the black plastic border outdoors and fencing around HVAC systems were monitored with chipped paint. G.S. 110-91(6); .0601(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. One existing caregiver's ITS-SIDS training certification expired April 26, 2025. .1102(f) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. Only two existing staff were linked in the ABCMS. There were eight former staff linked that need to be unlinked from the facility in the system. G.S. 110-90.2 & .2703(r) Technical Assistance and General Discussion: 1. It was recommended to purchase the third edition of the ERS. It was also recommended to review all available resources at the NCRLAP website. www.NCLRAP.org, including self-study for centers. It was recommended to participate in the DCDEE webinar related to QRIS and sign up for the provider meetings scheduled for September at CCRI. 2. As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on 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. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, September 11, 2025. You may email me with your letter of correction. Mail written documentation to Mara Brinton, 3687 Stallings Road, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: 0725-314L Visit Date: 8/12/2025 Number Present: 42 Completed Date: 8/12/2025 Age: From 0 To 5 Total Minutes: 90 Time In: 02:45 PM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Follow-Up Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during a Complaint Visit Follow Up. Upon arrival at the center, Ms. Davis, operator, was present and greeted me at the front door. A walk through of spaces #1-6 was conducted. Staff were asked about the staff meeting recently held and if they had any questions regarding child care rules. The center’s EMC plan posted in the hallway was monitored with three staff listed who were not working during the summer months. The posted plan was not current. It was recommended to speak with the staff and select staff who work year-round. The kitchen door was left open. No adult was monitored in the kitchen. The door was closed and locked. Ms. Davis was informed that the kitchen door was left open and unlocked. After the complaint visit on July 30, 2025. Ms. Davis developed and sent a memo to all staff stating whether any of the staff’s children between six weeks and twelve (12) years of age in need of childcare must be enrolled with the state-required paperwork. On August 8, 2025, Ms. Davis conducted a staff meeting. All staff signed a signature page indicating the policy was reviewed with them regarding staff’s children. No children were monitored in the staff’s lounge and children were in approved classrooms with adequate staff. Violation Number Comment Rule 832 There was no written emergency medical care (EMC) plan. The posted EMC plan had at least three staff listed who were not working during the summer months. 10A NCAC 09 .0802(a) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. The kitchen door was left open with hazardous products stored. .2820(b) Technical Assistance Provided and General Discussion: 1. It was recommended to prevent multiple staff from being able to access the kitchen. The key hook and key were monitored directly outside the kitchen door and the door was still left open and unlocked. It was also recommended to discuss this topic with staff during the next scheduled staff meeting. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Tuesday, August 26, 2025. You may email me with your letter of correction. Mail documentation to Mara Brinton, 3687 Stallings Road, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: ratio. Open / not marked corrected.

G.S. 110-91 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: 0725-314L Visit Date: 7/30/2025 Number Present: 40 Completed Date: 7/30/2025 Age: From 0 To 6 Total Minutes: 150 Time In: 12:00 PM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to investigate allegations of violations of child care requirements. Upon arrival at the five-star rated center, I was greeted at the front door by the operator, Ms. Betsy Davis. Ms. Davis asked why I was here. It was explained that allegations were received that school age children were permitted and cared for in the staff lounge, unsupervised. The administrator’s office and the teacher’s lounge were directly across the hallway from each other. No children were monitored in the teacher’s lounge upon my arrival. Ms. Besty Davis stated that she did permit one school-age child around the age of eight years old back in June to use the teacher’s lounge for two weeks while the child’s mother (NC Pre-K staff off for the summer) covered the infant room while a staff member was on vacation. Ms. Davis stated not knowing the staff member didn’t have care for the school-age child until the day the staff member showed up to work. There was not the required paperwork on file to show the child was enrolled. Ms. Davis stated the child would either be with her, in the teacher’s lounge or in a classroom but not always supervised according to child care rule. A walk through of spaces #1-6 was conducted, and present staff were interviewed regarding the allegations. Eight staff were interviewed and confirmed Ms. Davis’s statements. Based on my observations and discussion with the center and staff, the allegation of school-age children being served in an unapproved space was CONFIRMED. The teacher’s lounge, up front foyer area or administrator’s office was not approved space to care for children. One school age child was permitted to stay in the teacher’s lounge on and off for two weeks in June. Based on my observations and discussion with the center administrator and staff, the allegation of school-age children on-site and without the required proper paperwork/file was CONFIRMED. One school-age child was permitted to be on site every day for two weeks in June without the required paperwork. Based on my observations and discussion with the center administrator and staff, the allegation of school-age children was served in unapproved space and without adequate supervision was CONFIRMED. Ms. Davis stated a school-age child was permitted to use the teacher’s lounge on and off for two weeks in June. A qualified adult did not remain in the teacher’s lounge to provide adequate supervision for the school-age child. The last sanitation inspection was completed July 22, 2025, with seven demerits cited and a superior classification issued. Violation Number Comment Rule 209 Children used space that was not approved. A school-age child was permitted to use the teacher's lounge for two weeks in June. GS 110-91(1)&(4-5) 1328 Children's records were not made available for review. A school age child attended the facility for two weeks without a file. G.S. 110-91(9) 1424 School-aged children were not adequately supervised. A school age child was permitted to use the teacher's lounge for two weeks without adequate supervision. .2506(d)(1-3) Technical Assistance Provided and General Discussion: 1. We discussed getting the walls painted in the facility per last sanitation inspection report was noted as needed. Ms. Davis stated she is in process of getting the interior walls painted. 2. We discussed how the administrator could correct the cited violations to ensure this scenario doesn’t occur again. It was recommended to develop a policy statement in writing for staff as to the requirements for their children to attend the facility. 3. We discussed when the next staff meeting was scheduled and going over the newly developed policy with staff. Ms. Davis stated the next professional development day was scheduled for August 8, 2025. 4. We discussed expectations of adequate supervision of school-age children. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Wednesday, August 13, 2025. You may email me with your letter of correction. Mail documentation to Mara Brinton, 3687 Stallings Road, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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.

GS 110-91 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: 0725-314L Visit Date: 7/30/2025 Number Present: 40 Completed Date: 7/30/2025 Age: From 0 To 6 Total Minutes: 150 Time In: 12:00 PM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to investigate allegations of violations of child care requirements. Upon arrival at the five-star rated center, I was greeted at the front door by the operator, Ms. Betsy Davis. Ms. Davis asked why I was here. It was explained that allegations were received that school age children were permitted and cared for in the staff lounge, unsupervised. The administrator’s office and the teacher’s lounge were directly across the hallway from each other. No children were monitored in the teacher’s lounge upon my arrival. Ms. Besty Davis stated that she did permit one school-age child around the age of eight years old back in June to use the teacher’s lounge for two weeks while the child’s mother (NC Pre-K staff off for the summer) covered the infant room while a staff member was on vacation. Ms. Davis stated not knowing the staff member didn’t have care for the school-age child until the day the staff member showed up to work. There was not the required paperwork on file to show the child was enrolled. Ms. Davis stated the child would either be with her, in the teacher’s lounge or in a classroom but not always supervised according to child care rule. A walk through of spaces #1-6 was conducted, and present staff were interviewed regarding the allegations. Eight staff were interviewed and confirmed Ms. Davis’s statements. Based on my observations and discussion with the center and staff, the allegation of school-age children being served in an unapproved space was CONFIRMED. The teacher’s lounge, up front foyer area or administrator’s office was not approved space to care for children. One school age child was permitted to stay in the teacher’s lounge on and off for two weeks in June. Based on my observations and discussion with the center administrator and staff, the allegation of school-age children on-site and without the required proper paperwork/file was CONFIRMED. One school-age child was permitted to be on site every day for two weeks in June without the required paperwork. Based on my observations and discussion with the center administrator and staff, the allegation of school-age children was served in unapproved space and without adequate supervision was CONFIRMED. Ms. Davis stated a school-age child was permitted to use the teacher’s lounge on and off for two weeks in June. A qualified adult did not remain in the teacher’s lounge to provide adequate supervision for the school-age child. The last sanitation inspection was completed July 22, 2025, with seven demerits cited and a superior classification issued. Violation Number Comment Rule 209 Children used space that was not approved. A school-age child was permitted to use the teacher's lounge for two weeks in June. GS 110-91(1)&(4-5) 1328 Children's records were not made available for review. A school age child attended the facility for two weeks without a file. G.S. 110-91(9) 1424 School-aged children were not adequately supervised. A school age child was permitted to use the teacher's lounge for two weeks without adequate supervision. .2506(d)(1-3) Technical Assistance Provided and General Discussion: 1. We discussed getting the walls painted in the facility per last sanitation inspection report was noted as needed. Ms. Davis stated she is in process of getting the interior walls painted. 2. We discussed how the administrator could correct the cited violations to ensure this scenario doesn’t occur again. It was recommended to develop a policy statement in writing for staff as to the requirements for their children to attend the facility. 3. We discussed when the next staff meeting was scheduled and going over the newly developed policy with staff. Ms. Davis stated the next professional development day was scheduled for August 8, 2025. 4. We discussed expectations of adequate supervision of school-age children. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Wednesday, August 13, 2025. You may email me with your letter of correction. Mail documentation to Mara Brinton, 3687 Stallings Road, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/12/2025 Number Present: 59 Completed Date: 2/12/2025 Age: From 0 To 5 Total Minutes: 360 Time In: 09:30 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival at the center, I was greeted at the front door by the assistant administrator, Ms. Baldwin. The center maintained a five-star rated license and continued to meet enhanced ratios and space. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated November 2024 were used to document compliance. Spaces #1-6, kitchen and an outdoor learning environment were monitored for compliance. No transportation was provided for children. It was raining so the outdoor environment was only monitored from each classroom door. Children were monitored, engaged in free play, group time, eating lunch, and nap time. Seventy children were enrolled. Six children’s records were selected and monitored for compliance. The center’s approved and implemented curriculum with four-year-old children was monitored implemented with Teaching Strategies. Staff and Training worksheets were provided and monitored. One new staff member was hired since the last visit completed in September of 2024. One new staff file was monitored for S. Hyde. The presented staff and training worksheets were monitored for existing staff. Ms. Baldwin should continue to work to maintain the staff and training worksheets current. Two staff members did not have verifiable proof of CPR and FA training. One staff member had not completed Health and Safety training. The staff member was missing one remaining required training. Two staff members did not complete Recognizing and Responding to Child Maltreatment training within 90 days of employment. The annual review of the center’s EPR plan did not occur before staff’s annual review expired. The center’s EPR plan was monitored for compliance and current. The EPR ready to go file were monitored for compliance. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored. The daily attendance with children’s arrival and departure times were monitored documented and current for today. The outdoor learning environment was monitored for compliance. Monthly inspections were conducted and compliance issued noted and corrected. The last sanitation inspection was conducted February 5, 2025, eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 24, 2024. It was recommended to begin the annual inspection process 4-6 weeks prior to expiration. The DCDEE annual fire inspection report must be completed by the fire inspector. Violation Number Comment Rule 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A medication no longer needed and expired was not discarded or returned to the parent within 72 hours of parent indicating the child no longer required the medication. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Two staff members did not provide verifiable proof of obtaining the required training. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Two staff members did not provide verifiable proof of completion for CPR training. .1102(d) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The annual review of the center's EPR plan did not occur due to inclement weather in January of 2025. The annual review has not occurred before expiration. .0607(e) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip on file for a prescribed medication was valid for a year and not for six months. The permission slip expired. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 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. Two staff didn't obtain the required training within 90 days of employment. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. One staff member didn't complete the required training within one year of employment. One required training on medications was not obtained. .1102(a) Technical Assistance Provided and General Discussion: 1. It was recommended to purchase the third edition of ITERS and ECERS and begin training staff. There are several resources available on the NCRLAP website at www.NCRLAP.org. It was recommended to take advantage of the training available. 2. Ms. Baldwin was asked if she could print off an ABCMS roster report. She stated she was working but still faced some challenges with connecting every employee. I explained in the information emailed out were a telephone number and email address so providers could seek assistance with completing the requirements. During the visit I connected Ms. Baldwin to another administrator in the territory to assist her with some of the challenges. The center administrators must maintain their roster reports current. Any visit conducted by DCDEE could require the administrators to print the report. 3. As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. 4. We discussed only posting one menu in the hallway and kitchen only. A month’s worth of menus was posted, but last week’s menu was what anyone could see. The current menu was moved to the front of the posting. 5. We discussed ensuring staff list Foundational goals on their posted lesson plans. Most lesson plans were monitored with listed Foundational goals but there were at least two classrooms that did not have them listed. 6. We discussed how long could a container of milk be left out of the refrigerator. It was recommended to place the container of milk on a bowl of ice during lunch time. This would ensure the required temperature was maintained. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Wednesday, February 26, 2025. You may email me your letter of correction. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: ratio. Open / not marked corrected.

10A NCAC 09 .0902 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 9/12/2024 Number Present: 59 Completed Date: 9/12/2024 Age: From 0 To 5 Total Minutes: 210 Time In: 11:00 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during a routine unannounced visit. Upon arrival at the center the center the assistant administrator, Ms. LaJasmin Baldwin, was present and escorted me inside. The operator, Ms. Davis, was not present but arrived shortly after the visit began. The child care item number listing dated March 2024 was used to identify and determine non-compliance. The following sections were monitored for compliance: A1, B1, C4, C5, C6, E1, E2, F3, G1, G3, G4 and G5. A walk through of spaces #1- #6 were completed with Ms. Baldwin. Recommendations were made of ways to enhance the environments. Some additional toys and multiple of the same toys were lacking in a few centers. Ms. Baldwin stated additional materials have been ordered and are due in the next week or so. Children were monitored, engaged in playing outside, eating lunch and being read to by their teacher. There were plastic bags and materials with small parts accessible to two-year-old children in the hallway and in space #2. The glue sticks were moved and made inaccessible to children during the visit in space #2. The plastic bags were removed from the hallway cubbies during the visit. It was recommended to use fabric containers to hold the children’s extra clothing. Two infant feeding schedules were not transitioned from the infant room to the toddler room. In space #1, two feeding schedules were not posted. It was recommended to develop a transitional tracking tool to ensure all required items and paperwork is transferred with the children from one classroom to the another. The center’s EPR plan and RTGF were monitored current. There were three new staff hired since the last visit conducted June 17, 2024. Three new staff files were monitored for compliance and were found to meet child care requirements. Staff and training worksheets were not updated with the three new staff. Please update the worksheets and email them to me by tomorrow. Monthly outdoor inspections, incident log, monthly fire drills, quarterly safety drills, and playground inspections were monitored current and in compliance. The last sanitation inspection completed was July 23, 2024, with nine (9) demerits cited and a Superior classification issued. The last annual fire inspection was completed on September 14, 2024. It was highly recommended to begin the process of annual renewal six to eight weeks prior to expiration. The operator stated the fire department is due to return for reinspection, October 1, 2024. I informed Ms. Davis the annual fire inspection will expire, and a violation would be cited at her next visit. The annual inspection has not expired as of today. Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Sippy cups were monitored in the hallway cubbies not labeled or dated. 15A NCAC 18A .2804(d) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. (omit posting for centers located in a residence). Two infant feeding schedules were not transitioned to the one-year-old room, space #1. 10A NCAC 09 .0902(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. There were plastic zip lock bags in the hallway cubbies accessible to children under the age of three. The bags were removed during the visit. Glue sticks were made inaccessible to children in space #4 (two-year-old room). .0604(q) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding children’s transitions from one room to another. 2. Recommendations were made regarding staff education and ensuring a WORKS letter is on file for each staff member. 3. Recommendations were made regarding communication with parents related to water bottles needing to be labeled and dated daily. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, September 26, 2024. You may email me your letter of correction. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: ratio. Open / not marked corrected.

GS 110-91 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 6/17/2024 Number Present: 38 Completed Date: 6/17/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 12:30 PM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during a Routine Unannounced visit. Upon arrival at the five-star rated center the center administrator, Ms. Betty Davis greeted me at the front door. The DCDEE Child Care Center Item Number Listing dated March 2024 was used to verify non-compliance during the visit. The following compliance sections were monitored for compliance: A1-supervision, B1-ratio, C4-CPR, C5-FA, C6-special training, E1-storage of hazardous products, E2-storage of medicine, F3-space, G1-staff records, G3-program records, G4-license posted and G5-restrictions. A walkthrough of spaces #1-6 was completed with Ms. Davis. Children were observed participating in PM snack of Teddy Grahams and water, napping on cots with linen. Outside of each classroom are various items are posted. Two lesson plans were monitored posted (one outside and one inside of space #1). The lesson plan posted outside of the classroom was dated March 2024. The lesson plan posted inside was current. It was recommended to post the lesson plan inside of each classroom to ensure the current plan is inside and accessible. Several water bottles/sippy cups were monitored stored in cubbies without labeling or dating of each bottle. Parents must label and date each bottle prior to bringing their children to child care daily or the staff will be required to ensure compliance. Children’s changes of clothes were monitored stored in plastic zip lock bags and stored in cubbies. Plastic bags may not be accessible to children under the age of three. It was recommended to purchase string bags to store change of clothes. There empty items on monitored storage shelves. Some items were noted as dirty, but some monitored shelves did not have materials where a label was monitored. Ms. Davis stated staff were instructed to review materials and develop a request for materials. The following spaces needed additional materials or multiples of three of the same toys (space #1, #3). Recommendations were made regarding adding something live to each space. No new staff have been hired since the last annual compliance visit, February 15, 2024. Staff and Training Worksheets were printed and provided by Ms. Davis for review. The worksheets were monitored for compliance with existing staff related to safety certifications and CBC’s. The worksheets were reviewed to ensure existing and new staff had current CBC’s, CPR, FA, SIDS, Health, and Safety Training with Child Maltreatment Training. I highlighted in yellow items that needed to be updated and reviewed those items with Ms. Davis. Ms. Davis updated the forms manually and provided the current documentation for review prior to updating. The last sanitation inspection was conducted March 20, 2024, with ten (10) demerits cited and a Superior classification issued. The last fire inspection conducted was September 14, 2023. It was highly recommended to begin your annual inspection process four to six weeks prior to expiration. The last annual compliance visit was completed February 15, 2024. The last ERS was completed May 10, 2022. The RLA was last processed May 18, 2022. Based on the recent cohort plan to return to three-year reassessments, the program will not be required to complete a reassessment by May 18, 2025. Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The posted lesson plan posted outside of space #1 was not current. A current activity plan was posted during the visit. GS 110-91(12); .0508(a) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. Space #1 was monitored with center shelves with one bucket of materials offered. Missing items and multiples of three of the same toys were not available to children. .0510(e)(3) 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. Sippy cups were monitored not labeled or dated in the hallway cubbies. The sippy cups were labeled during the visit. 15A NCAC 18A .2804(d) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. One permission slip was monitored without a date in space #4. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) Technical Assistance Provided and General Discussion: 1. It was recommended to conduct a review of all classroom materials, labeling of shelves and staff working with younger children to teach them how to put their belongings back onto the shelves in their proper location. 2. It was recommended to develop a large daily schedule with pictures and times each transition would occur in the toddler and preschool classrooms. 3. We discussed ensuring parents label and date any sippy cups or bottles brought from home daily. There were several sippy cups monitored stored in children’s cubbies without a label or date on them. A staff person during the visit labeled each sippy cup/water bottle. 4. It was recommended to purchase bags that are not plastic to store children’s change of clothes. Zip lock bags or plastic may not be accessible to children under the age of three. 5. Styrofoam cups were monitored in use with children under the age of three for food service/drinks. It was recommended to use plastic cups and paper plates with children under age three. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Monday, July 1, 2024. You may email me your letter of correction. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .0601 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: ratio. Open / not marked corrected.

10A NCAC 09 .0509 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1001 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1002 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1003 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1004 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1005 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1401 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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 .1402 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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. 110-102 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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. 110-85 · Violation

Name of Operation: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: Visit Date: 2/15/2024 Number Present: 59 Completed Date: 2/15/2024 Age: From 0 To 5 Total Minutes: 395 Time In: 09:25 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor for compliance with applicable child care requirements during the Annual Compliance Visit. Upon arrival, I located Ms. Betsy Davis, center operator/administrator in the building. The center continued to maintain a five-star rated license and continued to meet enhanced space and ratios. The center continued approved to operate first and second shifts. The Annual Compliance Monitoring Checklist for Child Care Centers and the Child Care Item Number Listing dated August 2023 were used to document compliance. Fifty-nine children were present, ranging in age from five months up to Pre-K five years of age. There were not any school-age children present or enrolled. Six operating/approved spaces, kitchen, and outdoor learning environment were monitored for compliance. Children were monitored engaged in center time, outdoor play and eating their lunch, napping on cots with linen, hand washing, diapering, and eating PM snacks. We discussed and reviewed the posted menu. One lunch menu was listed as spaghetti, cheese, bread, vegetable, and milk. I inquired if any meat/protein was part of the menu listing because the amount of cheese needed to meet the nutritional requirement for protein would not be met. The cook stated they add turkey meat and I explained she will need to list the meat to the posted menu. We also discussed ensuring a variety of menu items are reflected. An email link was sent to the cook to review some kid friendly meals. We discussed not serving meatballs and serving ground meats instead. We talked about not serving hot dogs or whole grapes to children, regardless of their age due to potential choking hazards. There were not multiples of three of the same toys offered in each classroom for toddlers. (Space #1 and #4) We discussed implementation of the approved curriculum in the non-four-year-old classrooms. I inquired about quarterly assessments, teachers guide books, children’s hand writing samplings. We also discussed classrooms being able to show or indicate elements of the lesson plan theme in the classrooms. It was not always evident of the theme of the week. Additional children’s art work, live elements, family pictures were suggested. The infant room was monitored with cribs labeled, safe sleep checks, dirty toy bin, bottles labeled and dated, posted infant feeding schedules. The posted ITS-SIDS policy in space #6 was not the same policy monitored signed and dated on file. There were two evacuation cribs situated nearest to the exit door. A stroller was monitored stored outside of the classroom. Six children’s files were monitored for compliance. Six children did not have annual parental permission to participate in activities outside of the fenced area, like monthly fire drills. The center administrator was asked what the implemented curriculum was used in the center. Ms. Davis stated the center used The Creative Curriculum. While conducting the walk through of the center classrooms, I asked the teaching staff to show me their Teacher’s Guide Book, if quarterly assessments were completed and if each child had a portfolio. The Mecklenburg Pre-K staff were able to show all of the inquired indicators. It was recommended to work with the staff in the other classrooms to fully implement the curriculum in all classrooms. Staff and Training worksheets were not provided upon request. There were four new staff hired since the last Routine Unannounced visit completed in May of 2023. (T. Wise, M. Raye, S. Collins, and D. Dogan) Two existing staff files were monitored for compliance. (M. Villa and A. Brown) One staff was past due to obtain their five-year renewal of the health and safety training. One new staff did not have a medical prior to employment. Two existing staff files were monitored for compliance. Two existing staff did not have the current annual evaluation on file. The center’s EPR plan and RTGF were monitored for compliance. The EPR plan was not updated annually and was dated May of 2019. The child care consultant and health consultant’s information listed in the plan was not current. The RTGF was also monitored with missing required components. The missing components of the RTGF were blank incident reports, medical action plans attached to the child’s application, allergy list and area map. Documentation for quarterly safety drills and monthly fire drills were discussed and monitored for compliance. Monthly playground inspections were monitored and discussed with Ms. Davis. There was only one month where mulch was listed not in compliance. There were several things monitored and discussed with Ms. Davis regarding the outdoor environment. There was chipped paint on the fence railings, tripping hazard due to rain water washing away the land/dirt next to the side walk, hence causing a hazard to staff and children, fallen Gum Balls, and fallen tree brambles. The mulch monitored is decomposing and should be gutted and replaced with fresh mulch. The center does not provide transportation. If and when the center wanted to resume transporting children, the licensing consultant must be contacted. The last sanitation inspection was conducted October 4, 2023, with eight (8) demerits cited, and a Superior Classification issued. The last annual fire inspection was completed on September 14, 2023. It was highly recommended to begin the annual inspection process 4-6 weeks prior to expiration. The center will be due to complete a three-year reassessment later than May 18, 2025. The last ERS were completed on May 10, 2022. The overall average ERS was 6.05. It was recommended to review any items scored under a 5.0 with staff during staff meetings and pursue any CCRI grant programs to help with child environments and staff training/support. It was highly recommended to review and access all resources on the NCRLAP website at www.NCRLAP.org. There is a plethora of resources available. Violation Number Comment Rule 432 The center did not have developmentally appropriate equipment and materials accessible daily. Glue sticks were monitored in a cabinet in space #1 with children under the age of three. GS 110-91(12);10A NCAC 09 .0509(1) 488 For children under three years of age, materials were not offered in sufficient quantity to allow all children to use them at some time during the day and to allow for a range of choices. In spaces #1, #4 and #6 there were not multiples of three of the same toys offered to children. .0510(e)(3) 807 A safe indoor and outdoor environment was not provided for the children. Fallen Gum Balls and broken brambles were monitored on the ground throughout the outdoor environment, and tripping hazard. 10A NCAC 09 .0601(a) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. Plastic bags were monitored in the following spaces accessible to children: spaces #1, and #4. .0604(q) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The SIDS policy posted in space #6 was not the same policy on file and given to parents. The sample SIDS policy given to parents was a sample policy and not customized. One infant file was monitored without customization and signed policy. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One staff person was hired without a medical prior to hiring. 10A NCAC 09 .0701(a) 1322 A written statement from each child's parent giving standing permission which may be valid for up to twelve months for participation in off premise activities that occur on a regular basis was not available. Six children's files were monitored for compliance and none of the six children had current annual permission for off premises activities, like monthly fire drills. .1005(b)(4) 1812 The center did not complete an EPR Plan within four months of completing the EPR in Child Care training and/or the Plan was not completed on a template provided by the Division. The EPR plan was monitored and dated, May 2019. The consultant and health consultants contact information was not current. .0607(c) 1823 The EPR Plan did not include the location of the Ready to Go File and or the required information. The monitored RTGF was not current. There were not any blank incident reports, center allergy list, medical action plans attached to the child's application or area map. .0607(d)(10) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. One child with a chronic medical condition did not have a current medical action plan on file. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The permission slip was required every six months for a chronic medical condition. An Epi Pen and Benadryl were on file without permission to administer. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Two existing staff did not have completed documentation or proof on file to show they completed all training requirements related to health and safety training every five years. .1103(b) Technical Assistance Provided and General Discussion: 1. Recommendations were made regarding transportation, outdoor environment, outdoor play for infants, CCRI grants, developmentally appropriate activities, health and safety training requirements, CPR/FA requirements. 2. It was recommended to develop and alter children’s daily outdoor times to reflect the season. The center’s daily schedule should reflect the change to the time-of-day children go outside, weather permitting. 3. It was recommended to work towards the staff obtaining training on the selected curriculum. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (1) specifies that caregivers shall place infants aged 12 months or younger on their backs for sleeping, unless: (A) for an infant aged six months or less, the center receives a written waiver of this requirement from a health care professional; or (B) for an infant older than six months, the center receives a written waiver of this requirement from a health care professional, or a parent or a legal guardian; (2) specifies no pillows, wedges or other positioners, pillow-like toys, blankets, toys, bumper pads, quilts, sheepskins, loose bedding, towels and washcloths, or other objects may be placed with a sleeping infant aged 12 months or younger; (3) specifies that children shall not be swaddled; (4) specifies that nothing shall be placed over the head or face of an infant aged 12 months or younger when the infant is laid down to sleep; (5) specifies that the temperature in the room where infants aged 12 months or younger are sleeping does not exceed 75° F; (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (7) specifies how caregivers shall document compliance with visually checking on sleeping infants aged 12 months or younger; (8) specifies that pacifiers that attach to infant clothing shall not be used with sleeping infants; (9) specifies that infants aged 12 months or younger sleep alone in a crib, bassinet, play pen, mat, or cot; (10) specifies that infants aged 12 months or younger are prohibited from sleeping in sitting devices, including car safety seats, strollers, swings, and infant carriers. Infants that fall asleep in sitting devices shall be moved to a crib, bassinet, play pen, mat, or cot; and (11) specifies any other steps the center shall take to provide a safe sleep environment for infants aged 12 months or younger. (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (c) A copy of the center's safe sleep policy shall be given and explained to the parents of an infant aged 12 months or younger on or before the first day the infant attends the center. The parent shall sign a statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain: (1) the infant's name; (2) the date the infant first attended the center; (3) the date the center's safe sleep policy was given and explained to the parent; and (4) the date the parent signed the acknowledgement. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. (e) A caregiver shall place a child age 12 months or younger on the child's back for sleeping, unless for a child age 6 months or younger, the operator obtains a written waiver from a health care professional; or for a child older than 6 months, the operator obtains a written waiver from a health care professional or parent. Waivers shall include the following: (1) the infant's name and birth date; (2) the signature and date of the infant's health care professional or parent; (3) if a wedge is needed specify why it is needed and how it is to be used; and (4) the infant's authorized sleep positions. The center shall retain the waiver in the child's record as long as the child is enrolled at the center. (f) For each infant with a waiver on file at the center as specified in Paragraph (e) of this Rule, a notice shall be posted for quick reference near the infant's crib, bassinet, play pen, cot or mat that shall include: (1) the infant's name; (2) the infant's authorized sleep position; and (3) the location of the signed waiver. No confidential medical information, including an infant's medical diagnosis, shall be shown on the notice. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. (h) A bed, crib, or cot, equipped with a firm waterproof mattress at least four inches thick and a fitted sheet shall be provided for each child who remains in the center after midnight. The top of bunk beds shall be used by school-age children only. (i) A caregiver shall not place anything over the face of a child during rest time. SECTION .1000 - TRANSPORTATION STANDARDS 10A NCAC 09 .1001 SEAT AND CHILD SAFETY SEATS IN CHILD CARE CENTERS (a) When children enrolled in a child care center are being transported, each adult and child shall be restrained with an individual seat belt or child safety seat appropriate to the child’s age or weight in accordance with G.S. 20-135.2A located at http://www.buckleupnc.org/occupant-restraint-laws/seat-belt-law-summary/. (b) Only one person shall occupy each seat belt or child safety seat. 10A NCAC 09 .1002 SAFE VEHICLES (a) Vehicles used to transport children enrolled in child care centers shall be free of hazards such as, but not limited to, torn upholstery that allows children to remove the interior padding, broken windows, holes in the floor or roof, or tire treads of less than 2/32 of an inch. (b) Vehicles used to transport children enrolled in child care centers shall comply with all applicable State and federal laws and regulations. (c) Vehicles shall be insured for liability as required by State laws governing transportation of passengers pursuant to G.S. 20-279.21. (d) Vehicles used to transport children in snowy, icy, and other hazardous weather conditions must be equipped with snow tires or chains as appropriate. 10A NCAC 09 .1003 SAFE PROCEDURES (a) The driver or other staff member in the vehicle shall ensure that all children are transferred to an individual who is indicated on the child's application as specified in Rule .0801(a)(7) of this Chapter or as authorized by the parent. (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. (c) A First Aid kit and fire extinguisher shall be located in each vehicle used to transport children. The First Aid kit and fire extinguisher shall be mounted or secured if kept in the passenger compartment. (d) For each child being transported, identifying information, including the child's name, photograph, emergency contact information, and a copy of the emergency medical care information form required by Rule .0802(c) of this Chapter, shall be in the vehicle. (e) The driver shall: (1) be 21 years old or a licensed bus driver; (2) have a valid driver's license of the type required under North Carolina Motor Vehicle Law for the vehicle being driven or comparable license from the state in which the driver resides; and (3) have no convictions of Driving While Impaired (DWI) or any other impaired driving offense within the previous three years. (f) Each person in the vehicle shall be seated in the manufacturer's designated areas. No child shall ride in the load carrying area or floor of a vehicle. (g) Children shall not be left in a vehicle unattended by an adult. (h) Children shall be loaded and unloaded from curbside or in a safe, off-street area, out of the flow of traffic, so that they are protected from all traffic hazards. (i) Before children are transported, written permission from a parent shall be obtained that shall include when and where the child is to be transported, expected time of departure and arrival, and the transportation provider. (j) Parents may give standing permission, valid for up to 12 months, for transport of children to and from the center not including off premise activities as described in Rule .1005 of this Section. (k) When children are transported, staff in each vehicle shall have a functioning cellular telephone or other functioning two-way voice communication device. Staff shall not use cellular telephones or other functioning two-way voice communication devices except in the case of an emergency and only when the vehicle is parked in a safe location. (l) For routine transport of children to and from the center, staff shall have a list of the children being transported. Staff members shall use this list to document attendance as children board the vehicle and as they depart the vehicle. A list of all children being transported shall also be available at the center. 10A NCAC 09 .1004 STAFF/CHILD RATIOS (a) When children aged two years and older are being transported, the staff/child ratios required for compliance with child care center rules as set forth in Rule .0713 of this Chapter shall apply. The driver may be counted in the staff/child ratio. (b) When three or more children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver shall not be counted in the staff/child ratio. (c) When less than three children under the age of two years are being transported, the staff/child ratio requirements for child care centers set forth in Rule .0713 of this Chapter for children under age two shall be maintained. The driver may be counted in the staff/child ratio. 10A NCAC 09 .1005 OFF PREMISE ACTIVITIES IN CHILD CARE CENTERS (a) Off premise activities refer to any activity that takes place away from a child care center’s licensed and approved space. Licensed and approved space includes "primary space" as described in 10A NCAC 09 .1401(a), outdoor space as described in 10A NCAC 09 .1402, single use rooms, or other administrative areas. (b) When children participate in off premise activities the following shall apply: (1) Children under the age of three shall not participate in off premise activities that involve children being transported in a motor vehicle. (2) When children are transported in a motor vehicle for off premise activities, the provisions in Rule .1003(c) through (i) and (k) of this Chapter shall apply. (3) Before staff members walk children off premises for play or outings, the center shall obtain written permission from the parent of each child to be included in such activities. (4) Parents may provide a written statement giving standing permission which may be valid for up to 12 months for participation in off premise activities that occur on a regular basis. (5) The center shall post a schedule of off premise activities in each participating classroom where it can be viewed by parents, and a copy shall be given to parents. The schedule shall be current and shall include the: (A) location of the activity; (B) purpose of the activity; (C) time the activity will take place; (D) date of the activity; and (E) name of the person(s) to be contacted in the event of an emergency. (6) Each time that children are taken off the premises, staff shall take a list of the children participating in the activity with them. Staff members shall use this list to check attendance when leaving the center, periodically when the children are involved in the activity, before leaving the activity to return to the child care center, and upon return to the center. A list of all children participating in the off-premise activity shall also be available at the center. (c) The provisions of Subparagraphs (b)(1) and (5) of this Rule shall be waived to implement any child's Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician or other health professional; (c) in any manner not authorized by the child's parent, physician or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (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. (8) A parent may give a caregiver standing authorization to administer a single weight-appropriate dose of acetaminophen to a child in the event the child has a fever and a parent cannot be reached. The authorization shall be in writing and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (9) A parent may give a caregiver standing authorization to administer an over-the-counter medication as directed by the North Carolina State Health Director or designee, when there is a public health emergency as identified by the North Carolina State Health Director or designee. The authorization shall be in writing, may be valid for as long as the child is enrolled, and shall contain: (a) the child's name; (b) the signature of the parent; (c) the date the authorization was signed by the parent; and (d) the date that the authorization ends or a statement that the authorization is valid until withdrawn by the parent in writing. (10) Pursuant to G.S. 110-102.1A, a caregiver may administer medication to a child without parental authorization in the event of an emergency medical condition when the child's parent is unavailable, and providing the medication is administered with the authorization and in accordance with instructions from a bona fide medical care provider. (11) A parent may withdraw written authorization for the administration of medications at any time in writing. (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. (13) Any time prescription or over-the-counter medication is administered by center personnel to children receiving care, the following information shall be recorded: (a) the child's name; (b) the date the medication was given; (c) the time the medication was given; (d) the amount and the type of medication given; and (e) the name and signature of the person administering the medication. This information shall be noted on a medication permission slip, or on a separate form developed by the provider which includes the required information. This information shall be available for review by a representative of the Division during the time period the medication is being administered and for six months after the medication is administered. No documentation shall be required when items listed in Item (7) of this Rule are applied to children. (14) If medication is administered in error, whether administering the wrong dosage, giving to the wrong child, or giving the incorrect type of medicine, the child care center shall: (a) call 911 in accordance with CPR or First Aid training recommendations; (b) notify the center director; (c) contact the child's parent; (d) observe the child; and (e) document the medication error in writing, including: (i) the child's name and date of birth; (ii) the type and dosage of medication administered; (iii) the name of the person who administered the medication; (iv) the date and time of the error; (v) the signature of the child care administrator, the parent and the staff member who administered the medication; (vi) the actions taken by the center following the error; and (vii) the actions that will be taken by the center to prevent a future error. This documentation shall be maintained in the child's file. History Note: Authority G.S. 110-85; 110-91(1),(9); 110-102.1A; 143B-168.3; Effective July 1, 2023 Eff. January 1, 1986; Amended Eff. May 1, 2004; April 1, 2001; July 1, 1998; January 1, 1996; Readopted Eff. October 1, 2017. Corrective Action Plan: All violations must be corrected immediately. You shall submit a written, signed, and dated statement/compliance letter to me, at the address below detailing how each violation has been corrected and when. This information shall be received by Thursday, February 29, 2024. Mail written documentation to Mara Brinton, 7870 Woodmere Drive, Harrisburg, NC 28075. 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 or an administrative action may be recommended. 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. If you have any questions, please contact Mara Brinton at 704-594-0140 or email mara.brinton@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: LITTLE SPROUTS DAY ACADEMY Facility ID: 60003846 Consultant: MARA BRINTON Operation Type: Center Case Number: 0923-104L Visit Date: 9/19/2023 Number Present: 55 Completed Date: 9/19/2023 Age: From 0 To 5 Total Minutes: 365 Time In: 08:30 AM Time Out: 02:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to investigate allegations of violations of child care requirements during a complaint visit. Upon arrival to the center, I was greeted at the door by a caregiver. I inquired about where the center administrator was located, and the caregiver stated she was in the building. I located Ms. Betsy Davis standing outside of space #2. A parent/father was also standing next to Ms. Betsy. I greeted Ms. Betsy, and she came down the hallway to her office. I informed her I was here to investigate received complaint allegations. The parent/father came to the office and was upset a staff person remained working in his child’s classroom. I stated to the parent, I was here from the State to investigate. Ms. Betsy stated to the parent she had not received the allegations about the staff person until yesterday afternoon, the staff person did not work yesterday, and she had just arrived to talk directly to the staff person. The staff person was sent home until Ms. Betsy could address the staff person. A discussion was held about if the operator could require a staff person to take a drug test. I explained to Ms. Betsy she could ask a staff person to take a drug test and we would discuss further the received allegations and plan of action. The following allegations were read aloud to Ms. Betsy: There are concerns staff/child ratios are not being followed. There are concerns children are being cared for in an unsafe environment. There are concerns leftover formula/bottled beverage is not discarded (or returned home) as required. It is offered during the next feeding. There are concerns some safe sleep practices are not followed. Example: Infants are allowed to sleep in a bouncer and in a high chair. A walk through of spaces #1-6 were conducted with Ms. Betsy. Child Care enrollment and attendance worksheets were monitored for today and September 11, 2023. There were two Meck Pre-K classrooms where daily arrival and departure times are tracked through an IPOD. In all other spaces, a clip board with a daily tracking tool is used to document children’s daily arrival and departure times. Seven staff were interviewed regarding the allegations. The operator stated children are combined the first and last hour of operation for infant and toddlers. The daily arrival/departure tracking tools don’t show which classrooms children arrive to in the mornings. I provided a tracking tool for the center to consider using to track any child transitions in the building but especially in the mornings and late afternoons when children may transition to another space before departing for the day. In my interviews with staff, staff were asked what they are required to do if a parent/child arrive in the morning to their classroom and a second staff person was not in their classroom. Staff responded appropriately and indicated they were to ring their bell and ask the parent to please wait a moment while a second caregiver is sent to the room. Based on the discussions with staff and observations of daily arrival and departure times the allegation regarding not maintaining required staff to child ratios was UNSUBSTANTIATED. Seven staff were interviewed and inquired if they observed any other staff smoking or vaping. Staff were asked if they smelled any marijuana on any of their co-workers. Have any staff observed any behaviors of their coworkers that would be considered atypical. All staff stated, “no”. Ms. Betsy and I discussed that she could require employees to take a drug test if allegations were made. Ms. Betsy confirmed the child care facility was an “At Will” business. Ms. Betsy stated she was unaware because it was not explicitly written in her employee handbook. I contacted a DCDEE Abuse and Neglect Consultant to ask some questions regarding this topic. I confirmed with Ms. Betsy, she very well could ask an employee to submit for a drug test and if the employee refused, she had every right to terminate because the center was an “At Will” operation. Ms. Betsy stated she had not the time yet to complete her internal investigation of the allegations she received just yesterday. I was unable to interview the alleged employee. Based on the discussions conducted with staff and my observations the allegation that there are concerns children are being cared for in an unsafe environment was UNSUBSTANTIATED. Staff to child ratios were monitored in compliance. The environments were monitored with meeting child care requirements. None of the staff interviewed identified any other staff as being under the influence or smelling like marijuana. Ms. Betsy was asked if she does administer a drug test to share any results with DCDEE. Ms. Betsy stated a parent alleged a baby was sleeping in a bouncer seat. Ms. Betsy stated asking additional questions to the parent to be able to speak with staff in the applicable classroom but stated the other parent cut her off. She stated speaking to the infant staff. I spoke to the infant staff to ask how they handle an infant falling asleep if they are also in the process of handling another infant at the same time and a parent or any adult from the outside arrives to the room. There are times when there may only be one caregiver in the room, or all eight infants are present with two caregivers who hands may be full or they are doing something when an infant falls asleep in anything else but their cribs. I encouraged Ms. Betsy and staff to verbalize to any adult that as soon as they finish, they will immediately place the sleeping infant in their assigned cribs. All SIDS rules were monitored and met child care requirements when monitored this morning. Infant staff were also asked how unfinished bottles are handled. Four staff were interviewed who work in the infant room. Each staff person responded appropriately regarding once an infant is finished with their feeding, whether the bottle is completed or not understands any unused formula would be discarded and empty bottle returned home. I encouraged Ms. Betsy to review this policy with all infant staff again and with infant parents. Based on my observations and discussions with staff the allegation that there are concerns leftover formula/bottled beverage is not discarded (or returned home) as required was UNSUBSTANTIATED. It is offered during the next feeding. Bottles are made daily by infant parents not center staff. Bottles are labeled and dated daily. Interviewed staff each acknowledged proper procedure and no staff stated giving an infant a bottle from the day before. Either the contents are discarded or unused bottles are returned home daily. Based on my observations and discussions with staff the allegation that there are concerns some safe sleep practices are not followed. Example: Infants are allowed to sleep in a bouncer and in a high chair. No infants were monitored sleeping in a bouncy seat. Staff interviewed were fully aware of the child care rule and what the proper actions warrant of them when and if an infant fell asleep outside of their assigned crib. Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The center's annual fire inspection was due no later than September 12, 2023. It was not obtained until September 14, 2023. 10A NCAC 09 .0304(a) Technical Assistance Provided and General Discussion: 1. We discussed current implemented curriculum of Creative Curriculum. I inquired if quarterly assessments were completed by staff and shared with parents. I highly recommend fully implementing the curriculum. By doing this there is documentation four times a year to show how each child is developing and this documentation should be used when considering if a child is developmentally ready to move up to the next room. A determination to move a child up should be based on developmental ages and stages of individual children and if there is current space for the child to move up. A child should not be moved up just because a parent is not happy with their current caregiver. 2. It was recommended to review ITS-SIDS rules with all infant caregiving staff, communicate the same policies with enrolled parents. Review sanitation rules related to shared common spaces like bouncy seats. 3. It was recommended to review daily bottle requirements and feeding requirements with infant staff and enrolled infant parents. 4. It was recommended to use the provided tracking tool to track children transitions at arrival and throughout the day. 5. It was recommended to communicate with all parents in the infant room regarding the allegations, training of staff and administrative oversight and need for open communication. 6. We discussed beginning the annual fire inspection process 4-6 weeks prior to expiration. The annual fire inspection was due no later than September 12, 2023. It was not obtained until September 14, 2023. If you have any questions or concerns, please contact Mara Brinton at 704-594-0140 or by email at Mara.Brinton@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: ratio. Open / not marked corrected.