10A NCAC 09 .0304 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0606 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 1/24/2025 Number Present: 45 Completed Date: 1/24/2025 Age: From 0 To 5 Total Minutes: 260 Time In: 09:20 AM Time Out: 01:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Ms. Worley accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-six (86) percent as of today prior to this visit. Permit type – five-star center license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 7/25/24. The last fire drill was practiced on 12/20/24. The last lockdown drill was practiced on 11/20/24. The last playground inspection was documented on 1/15/25. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/16/24 with five (5) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space #3&4, a group of four-to-five-year-old children engaged in free play with magnetic tiles, blocks, housekeeping accessories. Two (2) children played with a tablet. Screen time log was appropriately filled out. In space #5, a group of one-year-old children explored the environment and materials. A group of two-year-old children from space #6 engaged in gross motor activities in multi-purpose room with climbers and toy vehicles. Some children ran in the space. In space #8, a group of three-year-old children played with housekeeping accessories and manipulatives. A conflict between two (2) children were facilitated to be resolved by Ms. Worley during the visit. A group of two-year-old children joined the children from space #6 in the multi-purpose room during the visit. In space #12, a group of one-year-old children explored materials, such as music instruments and climbers in the classroom. In space #14, two (2) infants were present. One (1) child was asleep in the crib, and the other child was held by the teacher. Space #1, 2, #7, #9, #11, and #13 were not used during the visit. Interaction and supervision were appropriate. All prescription medications and over-the-counter medications were monitored. All permission forms and action plans were valid. Fourteen (14) existing staff members files were monitored partially for criminal background letters, first aid/CPR certificate and ITS/SIDS certificate. Four (4) new staff members files were monitored in full. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was not reviewed today. Due to Tropical Storm Helene, NC Pre-K sites will not be required to complete the site monitoring tool and will not receive annual monitoring from NC Pre-K contractors for FY 2024-2025. Two (2) children files were monitored today. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Children's Benadryl in space #5, room 125 was maintained in the backpack. The backpack was stored above five (5) feet but not in a locked storage. 15A NCAC 18A .2820(d) 871 Center staff did not comply with the safe sleep policy. In space #14, room 207, an infant was asleep in the crib during the visit at 10:45 am. The sleep check chart for the child was not filled out. 10A NCAC 09 .0606(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. O. Cook hired on 1/22/25 and E. Sutton hired on 11/25/24 did not have a choice of health care professional listed on their emergency information forms. 10A NCAC 09 .0701(a) Technical assistance was provided as follows: 841: Storage of medication Prescription and over-the-counter medications, except for emergency rescue medications, shall be stored in a locked storage. Creams, such as lotions and diaper creams do not have to be locked. Benadryl is considered a over-the-counter medication and not an emergency rescue medication. Therefore, the medication shall be stored in a locked storage. You can put small lock with a key to the zipper of the backpack store the Benadryl elsewhere. Please refer to 15A NCAC 18A .2820(d). 871: Safe Sleep practice – sleep check. Per 10 A NCAC 09 .0606(a)(6), fifteen (15) minute sleep check must be conducted for all infants, and the record of the sleep check must be maintained for review. 1035: Emergency Information Form Child care providers, including the director, uncompensated providers, substitute providers, and volunteers shall have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. Please have O. Cook list the choice of health professionals on the emergency information form. E. Sutton corrected the emergency information form during the visit. Additional technical assistance was provided for the following items. Due to the effects of Tropical Storm Helene, additional time was permitted to meet compliance for the following items: 106: fire inspection The last fire inspection was completed on 11/7/23. The Fire Marshall was contacted, but the inspection had not been completed yet. Ms. Worley will notify the Fire Marshall and make additional request to complete the inspection. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/7/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Reminders: Medication authorization forms for the following medications are expiring sometime soon: Space #201: the form for Eavate Sunscreen for N.V. will expire on 2/28/24, and 1/23/24 for E.T. and G. B. In space 308, the form for Boudreaux’s Butt Paste for C.C. will expire on 2/5/25. Lead Paint and Asbestos Testing: In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0511 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0607 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0806 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0901 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1301 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2505 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 7/25/2024 Number Present: 66 Completed Date: 7/25/2024 Age: From 0 To 8 Total Minutes: 380 Time In: 09:40 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 visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. A signed copy of the visit summary was electronically emailed to you. Eight (8) children's files were monitored and all children's files were in compliance. Today, Ms. Worley accompanied me. Indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today prior to this visit. The North Carolina Secretary of State website was viewed prior to today’s visit and the non-profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 7/24/24. Permit type – Five-star license issued on 11/3/23. Special Services/Restrictions – daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 6/12/24. The last shelter-in-place drill was practiced on 5/13/24. The last playground inspection was documented on 7/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 6/12/24 with two (2) demerit for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. Space #1 and #2 were not in use during the visit. The children from space #3 & 4 played on the playground in the rain. The children played in the puddles, sandbox and other playground equipment. No emergency medications were maintained in the classroom, and no hazardous materials were found. In space #5, a group of one-year-old children were observed during rest time. Two (2) children were still awake, and one (1) teacher assisted the child to fall asleep. One (1) of the children’s face was covered with his/her blanket. Space #6 was closed during the visit due to staff shortage. The children were counted in space #7. Four (4 ) children’s permission form for Equate sunscreen was expired on 4/6/24, 6/6/24, 2/25/24 and 7/11/24. 4 packs of baby wipes with warning label was maintained at approximately 36 inches. In space #7, children were observed during lunch time. Today’s lunch was chicken and waffle, peas, blueberries and milk. One (1) of the children had water in the sippy cup. The child has milk allergy and Lactaid was supposed to be served. The child’s name was not listed on the allergy list posted in the classroom. The child’s allergy was listed in the kitchen. The child typically attends space #6, the allergy is listed in the classroom. Additionally, the staff members in space #7 were not typical staff members. One (1) of the staff members was aware that the child could not have regular milk and served water instead because the staff member did not know what types of milk to be served. During the meal, one (1) teacher was at the sink by the bathroom aiding four (4) children wash their hands, and the other teacher was serving children food and milk. At the end of the meal, one (1) teacher aided a child clean up his/her plate, and the other teacher aided three (3) children throw away milk in the sink by the refrigerator. Two (2) children were still at the table and eating lunch. Due to this item being marked down for ITERS-R assessment, Ms. Worley and I had discussion about supervision during meal time. Per interview, Ms. Worley’s understanding of being able to see and hear during the meal time was for the staff members to be able to check children and were allowed to be engaged in other activities, such as aiding children clean up and washing hands. I explained to Ms. Worley that one (1) teacher’s eye must be on the children at all times while they eat. I suggested teachers in the classroom to communicate with one another throughout the meal time to make sure that one (1) teacher can see and hear the children at all times. In space #8, a group of two-to-four-year-old children engaged in dance activities with two (2) teachers. Head Count sheet was monitored and the log was not to date as of 10:30 am. Space #9 was not in use during the visit. In space #10, a group of three-to-five-year-old children engaged in free play with manipulatives, dress-up clothes, housekeeping materials, art and blocks. One (1) emergency medication was stored in the backpack, and its action plan and the permission form were current. Permission forms for Equate sunscreen were not signed by the parents. The permission form for Neutrogena Ultra Sheer sunscreen expired on 7/7/24. Blue Lizard Australian aerosol sunscreen was not stored in a locked storage, and the permission form was not in file. A permission form for Badger Sport sunscreen was not in the file. Per interview with the teacher, sunscreens have been applied to the children. Space #11 was not in use during the visit. In space #12, a group of seven (7) children, one (1) year of age, had lunch. One (1) teacher served the children food and pushed the cart outside of the classroom. One (1) teacher changed the diaper of a child while six (6) children ate breakfast. Supervision was discussed for this case as well. Per Ms. Worley, the teacher changing diaper face the direction of the tables and was able to see the children eating. However, some children were facing their backs to the teacher at the changing table. Therefore, he/she could not see and hear the child while the other teacher pushed the cart out of the classroom. After the discussion, one (1) teacher sat by the table and supervised the children’s eating. During the meal, one (1) child fell asleep while seated at the table. One (1) teacher was sitting on the floor next to the child and quickly realized the child fell asleep. The child’s mouth was checked to make sure that no food was left in the mouth. Technical assistance was provided today for supervision during the meal. It is crucial for teachers to be able to see the children during the meal due to most choking occurs silently. Space 13 was closed during the visit. In space #14, five (5) infants engaged in various activities. One (1) infant was asleep in the crib, one (1) being rocked by a teacher, and three (3) were on the floor playing with toys. One (1) child was held and fed a bottle later. The sleep chart was filled out appropriately. The children were picked up appropriately during the visit. Various batteries were found in the cabinet with baby proofing device. The head count log was not filled up to date at 9:30 am. One (1) emergency medication and over-the-counter creams/lotions were maintained in the classroom. All forms, expiration of the medications and storage were in compliance. Due to space #13 being closed due to staff shortages, three (3) children from the room were brought to the classroom. One (1) of the feeding plans was not signed by the parents. The temperature of the refrigerator was 41 degrees. We have discussed prep-year assessment results: The facility scored 6 pts for ECERS-R assessment. Item 8: you scored 4 pts for this item. This is not a licensing requirement. Item 11: you scored 2pts for this item. Per 15A NCAC 18A .2821 BEDS, COTS, MATS, AND LINENS (a), in child care centers, all beds, cribs, cots and mats shall be in good repair, stored to prevent contamination, cleaned and sanitized between users. Item 14: you scored 2 pts for this item. Per 15A NCAC 18A .2820 STORAGE, potentially hazardous materials shall be inaccessible to the children. You shall read the labels and follow the directions appropriately. (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4pts for this item. This is not a licensing requirement. Item 37: You scored 2pts for this item. This is not a licensing requirement. The program received two (2) ITERS-R assessments. The first classroom received a score of 5.07. Item 2: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7: you scored 2 pts for this item. Per 10A NCAC 09 .2505 HEALTH REQUIREMENTS FOR CHILDREN (c)(2), safe drinking water shall be available at all times regardless of where activities are provided. Item 7, indicator 3.4: Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This item was reviewed for ECERS-R item 11. Item 9: you scored 2 pts for this item. 15A NCAC 18A .2803 HANDWASHING (a) Child Care operators shall instruct employees that handwashing is the single most important line of defense in preventing the transmission of disease-causing organisms. Employees shall wash hands upon reporting for work; before and after handling food; before bottle feeding or serving to other children; before handling clean utensils or equipment; after toileting or handling of body fluids (e.g., saliva, nasal secretions, vomitus, feces, urine, blood, secretions from sores, pustulant discharge); after diaper changing; after handling soiled items such as garbage, mops, cloths and clothing; after being outdoors; after handling animals or animal cages; and after removing disposable gloves. The use of hand sanitizing products does not replace the requirement for handwashing. However, except for diapering, food preparation, and food service, hand sanitizing products may be used in lieu of handwashing while an employee is supervising children outdoors if hands are washed upon returning indoors. Item 10: you scored 1 pt for this item. Designated sick area shall be available out of the classroom or in the classroom away from areas used by children. Per 15A NCAC 18A .2827 COMMUNICABLE DISEASES AND CONDITIONS, (b) Each child care center shall include a designated area for a child who becomes ill to the extent that she or he can no longer participate in the routine group activities. When in use, such area shall be equipped with a bed, cot or mat and a vomitus receptacle. Thermometers and all materials used in the designated area including mouthable toys shall be cleaned and sanitized after each use. Linens and disposables shall be changed after each use. (c) If the area is not a separate room, it shall be separated from space used by other children by a partition, screen or other means. The designated area shall be located so that health and sanitation measures can be carried out without interrupting activities of other children and staff. Item 11: you scored 4 pts for this item. Styrofoam plates and bowels are permitted for children under three (3) years of age with close supervision. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item 15: you scored 4 pts for this item. This is not a licensing requirement. Item 18: you scored 4 pts for this item. This is a licensing requirement. Item 19: You scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 4 pts for this item. This is not a licensing requirement. Item 29: you scored 4 pts for this item. This is not a licensing requirement. However, a smooth transition without lengthy wait time is critical for behavioral management. The score for the second ITERS-R was 4.71. Item 4: you scored 4 pts for this item. Even though room arrangement is not a violation of licensing rules, it is important to arrange the classroom to maximize supervision. Item 5: you scored 4 pts for this item. This is not a licensing requirement. Item 6: you scored 2 pts for this item. This is not a licensing requirement. Item 7, indicator 3.4: you scored 2 pts for this item. Per 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS, (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item 8: you scored 2 pts for this item. This is not a licensing requirement. Item 9: you scored 2 pts for this item. Per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS (a) Diapers shall be changed whenever they become soiled or wet and not on a shift basis. Item 11: you scored 4 pts for this item. All teachers shall learn safe ways to lift children minimizing the risk of injury. Item 13: you scored 4 pts for this item. Per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE (b) The caregivers shall interact in a positive manner with each child every day, as follows: (1) caregivers shall respond at the earliest opportunity to an infant or toddler's physical and emotional needs, especially when indicated by crying, through actions such as feeding, diapering, holding, positive touching, smiling, talking, and eye contact; Item 16: you scored 4 pts for this item. Per (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity, for no less than the following durations: program operates five (5) hours or more shall provide children two (2) to twelve (12) years of age minimum of six (60) minutes of daily outdoor time. Thirty (30) minutes of outdoor time is required for children under two (2) years of age. Item 17: you scored 4 pts for this item. This is not a licensing requirement. Item 22: you scored 3 pts for this item. This is not a licensing requirement. Item 27: you scored 4 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 28: you scored 2 pts for this item. The same requirements are applied to this item per 10A NCAC 09 .0511 DAILY ROUTINES FOR CHILDREN UNDER TWO YEARS OF AGE. Item 29: you scored 1 pt for this item. The same requirements are applied to this item per 10A NCAC 09 .0806 TOILETING, CLOTHING AND LINENS. The immediate concerns are follows: • Supervision of children during meal time • Lifting of children • Diaper changing schedule • Meeting infants and toddlers’ emotional needs. During the visit, supervision of children during the visit was discussed in detail. I did not observed any inappropriate lifting of children during the visit. Diaper change was conducted as needed during the visit. Infants and toddler's needs were met at earliest opportunities possible during the visit. Please review the child care rules and your procedures to make improvements as needed. Six (6) new staff files and three (3) existing staff files were monitored in full. One (1) new staff member was not listed on the Staff and Training Worksheet. Four (4) files were monitored partially for incorrect dates on the Staff and Training Worksheet. All staff files were in compliance. ABCMS system was checked on 7/24/24. Some staff member could not be found on ABCMS system due to different last or first names. Their CBC letter was monitored during the visit. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were not monitored for compliance due to NC Pre-K classroom being closed for the summer. This item will be monitored during a routine unannounced visit. The following violations were documented during today’s visit: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #14, a child's feeding plan was posted but not signed by the parent. .0902(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. In space #8, one (1) can of Babyganics Mineral sunscreen aerosol spray was stored in the closed, but the closet door was not locked. In space #10, a can of Blue Lizard Australian aerosol sunscreen was stored in a tool box on top of the cabinet without lockable device. In space #14, C, D, 9V and AAA batteries were stored in the cabinet by the entrance door with baby-proofing device. .2820(b) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. Per teacher interview in space #10, Equate sunscreen was applied to the children without the permission forms. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, the permission form for diaper creams expired for four (4) children on 2/25/24, 4/6/24, 6/6/24 and 7/11/24. In space 10, the permission forms for Equate SPF 50 sunscreens dates for 6/27/24 0 6/27/25 were not signed by the parents for sixteen (16) children. The permission form for Neutrogena Ultra Sheet sunscreen expired on 7/7/24. The permission form for Blue Lizard Australian aerosol sunscreen was not in file. No permission form for Badger Sport sunscreen was not in file. 10A NCAC 09 .0803(4)(6-9) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. In space #12, Aquaphor Healing Ointment expired in April, 2024 but was not returned to the parents or discarded. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In Space #7, fifteen (15) bags of baby wipes were maintained at approximately thirty-six (36) inches high. Plastic cups in the plastic wrappers were stored in the bottom shelf under the refrigerator. There were eleven (11) children, two (2) years of age, were present in space #7. In space #8, two packs of diapers in plastic wrappers and Members Mark premium baby wipes were stored at thirty-six (36) inches high. There were one (1) child, two (2) years of age was present in the classroom. .0604(q) 883 During the required fire, lockdown, or shelter-in-place drills, the evacuation crib or other approved device was not used as described in the EPR Plan. In space #12, a wooden table was stored in a evacuation crib. During the transition from gross motor room to the classroom, two (2) wagons were used to transport the children. Therefore, the need of the evacuation crib during evacuation is necessary for at least some of the one-year-old children. The use of evacuation crib is noted on the EPR plan. With a wooden table being stored in the evacuation crib, the proper procedure of the EPR plan was not followed. .0604(r) Technical assistance was provided as follows: 541: Feeding plans Feeding plans shall be created for all children under fifteen (15) months of age. The plan shall be reviewed by the parents, signed and posted. 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. 601: Refrigerator temperature The temperature in the refrigerator shall be forty-five (45) degree or lower. In space #14 and #12, the refrigerator temperature may be affected by the build up of ice. I recommend them to be defrosted periodically to make sure that the coolant works well. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (h) Refrigerated storage: (2) Potentially hazardous food requiring refrigeration after preparation shall be cooled to an internal temperature of 45°F (7°C), or below. Cooling of potentially hazardous foods shall be initiated upon completion of preparation or hot storage. Methods such as pouring into pans, agitation, and chilling with ice or water circulation external to the food containers shall be used to cool potentially hazardous food. Potentially hazardous food to be transported cold shall be prechilled and held at a temperature of 45°F (7°C) or below. 840: storage of hazardous products Potentially hazardous products, such as batteries and aerosol sprays must be stored in a locked storage. When defining a locked storage, it must have a key and a lock, magnetic lock or a combination lock. Baby proof device are not considered a locked storage. 15A NCAC 18A .2820 STORAGE (b) 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 shall be kept in its original container or in another labeled container, used according to the manufacturer's instructions and stored in a locked storage room or cabinet when not in use. Locked storage rooms and cabinets shall include those which are unlocked with a combination, electronic or magnetic device, key, or equivalent locking device. These unlocking devices shall be kept out of the reach of a child and shall not be stored in the lock. Toxic substances shall be stored below or separate from medications and food. Any product not listed above, which is labeled "keep out of reach of children" without any other warnings, shall be kept inaccessible to children when not in use, but is not required to be kept in locked storage. The product shall be considered inaccessible to children when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor. 842: Medication application No medication, prescription or over-the-counter lotions can be applied to the children without parental permission form. When the permission form expires, the medication can no longer be applied to the children until the new form is filled out. 10A NCAC 09 .0803 ADMINISTERING 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. 847: Medication permission form When the medication permission form is filled, all sections of the forms must be filled out. Additionally, generic names, such as diaper cream and/or sunscreen are not accepted. The brand of the products must be on the form. Only one (1) product can be listed on each form. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. 849: Left-over medications Left-over medications shall be discarded or returned to the parents within seventy-two (72) hours of their expiration dates. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. 858: plastics Easily torn plastics, such as Ziplock bags, plastic wrappers and some baby wipe bags shall be inaccessible to the children. Upon storing diapers, the plastic wrappers shall be removed. Baby wipes shall be stored in a plastic box or the plastic bags without a warning to keep out of children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. 883: Evacuation Crib The use of evacuation crib on your EPR plan was written as follows: “Evacuation crib will be used to evacuate infants and non-mobile children”. Therefore, the evacuation crib shall be ready for use at all times. The evacuation crib shall be empty and ready to be used. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (r) When non-ambulatory children are in care, a crib or other device shall be available for evacuation in case of fire or other emergency. The crib or other device shall be fitted with wheels in order to be moveable, have a reinforced bottom, and shall be able to fit through the designated fire exit. For centers that do not meet NC Building Code for institutional occupancy as described in 10A NCAC 09 .1301, and have an exit more than eight inches above grade, the center shall develop a written plan to ensure a safe evacuation of the crib or other device. The operator shall submit the plan to the Division for review. The Division shall approve the plan and shall require a demonstration of the center implementing the plan during a drill. During the required fire, lockdown, or shelter-in-place drills, an evacuation crib or other device shall be used in the manner described in the Emergency Preparedness and Response Plan as defined in 10A NCAC 09 .0607(c). Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/8/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Supervision during the meal time: It is best practice for at least one (1) staff member to be sitting at the table while children are eating due to potential risk of choking. Additionally, this increases quality by allowing staff to interact and engage with children regarding healthy eating habits and food exploration. Head Count Sheet: It is a recommendation and best practice that teachers follow center procedures as a supplemental practice to ensure supervision of children is consistent and adequate as required by child care rule .1801. Appropriate staff training on use of the checklist will additionally ensure adequate supervision during children and staff transitions to approved indoor and outdoor spaces. When children from different classrooms are combined and when regular teachers are not present, the checklist should be unutilized to prevent mistakes more closely than typical occasions. 501: Nutrition requirements: Due to staff shortages, the mistake of not feeding required milk alternative occurred during the visit today. Due to challenging circumstances, the violation was not cited during today's visit. Nutrition requirements set by USDA shall be met and all components shall be served to each child. If a child has food allergies or intolerance, proper substitute items shall be served. 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (a) Meals and snacks served to children in a child care center shall comply with the Meal Patterns for Children in Child Care Programs from the United States Department of Agriculture (USDA) which are based on the recommended nutrient intake judged by the National Research Council to be adequate for maintaining good nutrition. The types of food, number and size of servings shall be appropriate for the ages and developmental levels of the children in care. The Meal Patterns for Children in Child Care Programs are incorporated by reference and include subsequent amendments. A copy of the Meal Patterns for Children in Child Care Programs is available online at https://www.fns.usda.gov/cacfp/meals-and-snacks. Reminders: The permission form for A+D ointment will expire on 8/28/24 in space #12. The permission form for Aquaphor for a child will expire on 8/1/24 in space #6. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 2/6/2024 Number Present: 75 Completed Date: 2/6/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 09:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site and/or electronically emailed to you. Today, Denise Worley, Administrator, accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today. Permit type – Five-star center license issued on 11/3/23. Special Services/Restrictions: daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 1/3/24. The last shelter-in-place drill was practiced on 11/30/23. The last playground inspection was documented on 2/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/15/23 with zero (0) demerit for a superior classification. The Emergency Medical Care plan was posted and is current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space 3/4 (Rm, 119/122), the NC Pre-K children engaged in gross motor play on the playground. The children rode bikes, ran and played with sand. In space 5 (Rm 125) a group of one-year-old children engaged in free play. One (1) child’s diaper was changed, and the procedure was adequately followed. The other children explored the environment and washed other children on the playground. A group of two-year-old children from space 6 and 7 (Rm 201 and 204) played on the playground. The children rode riding toys and other accessories. In space 8 (Rm 308), a group of three-year-old children played with classroom materials during free play. The children built structures with blocks, created free art with brush paint. One (1) child rested on the child-size sofa in the library area. In Space 10 (Rm 314), a group of three-to-four-year-old children engaged in free play with magnetic tiles, brush paint, playdough, marker, sand, water and blocks. Thermometer was not in the refrigerator, but it was corrected during the visit. In space 12 (Rm 328), a group of one-year-old children engaged in gross motor play in the classroom. The children played with a climber and a tunnel. In space 13 (Rm 208), a group of infants explored the environment. One (1) child was held by a teacher, one (1) child was in a bouncer and the other children played with a beachball with another teacher. In space 14 (Rm207), a group of infants participated in reading time. The teacher read two (2) books to the children. One (1) child was falling asleep in the arm as the teacher read the books. Permission forms for diaper creams, over-the-counter lotions, lipbalms were monitored. All forms were valid. There is one (1) emergency medication maintained at this facility. The action plan and the medication authorization form were current. Today's lunch was beef taco, black beans and pineapple tidbits. Space 1, 2, 9, 11 were not in use during the visit. All existing staff files were monitored for criminal background letters, CPR/First Aid certificate and ITS/SIDS certificates. Three (3) new staff member’s files were monitored in full. Two (2) NC Pre-K children’s files were monitored due to annual compliance visit takes place during the summer. Dial-4 is used for Developmental Screening. Teeth exam, vision and hearing were included in physical exam. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was reviewed. The monitoring tool was reviewed by Dr. Barbra Jeffrey’s of Region A on 12/13/23. Two (2) children files were monitored today due to NC Pre-K classroom being closed during the last Annual Compliance visit. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. There was no thermometer in the refrigerator in space 10 (Room 314). 15A NCAC 18A .2806(j)(2) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete First Aid training before 12/18/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete CPR training before 12/18/23. .1102(d) Technical assistance was provided as follows: 601: Refrigerator temperature Refrigerator temperature must be maintained under forty-five (45) degree. Thermometer shall be placed in all refrigerators. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (f) All food shall be stored in a manner to protect it from dust, rodents, insects, drip, splash and other contamination. Raw meats, poultry, fish, shellfish and eggs shall be stored on shelving beneath and separate from other foods. The temperature of potentially hazardous food provided by the center shall be 45°F (7°C) or below, or 140°F (60°C) or above at all times, including field trips, catering events, outdoor service, except during necessary periods of preparation and service, and as otherwise provided in the Rules of this Section. 1048: First Aid 1049: CPR 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS Staff members shall obtain First aid and CPR certification within ninety(90) days of employment. First Aid and CPR training is provided by the campus security personnel at this facility. If, in any case, you are unable to complete the training within the agency, please contact other organizations, such as Hear Saver and Red Cross. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/20/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Rated License Cohort: Haywood Community College Regional Center for the Advancement of Children is in cohort one (1). Your prep-year is current through July 2024, and the assessment year will be July 2024 through June 2025. We have discussed prep-year assessment. Ms. Worley is planning to apply in April 2024 and wishes to go through the assessment in May 2024. Reminder: CPR/First Aid certificate for DW will expire on 3/30/24. Shelter-in-place is due this month. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556-9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .1102 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 2/6/2024 Number Present: 75 Completed Date: 2/6/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 09:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site and/or electronically emailed to you. Today, Denise Worley, Administrator, accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today. Permit type – Five-star center license issued on 11/3/23. Special Services/Restrictions: daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 1/3/24. The last shelter-in-place drill was practiced on 11/30/23. The last playground inspection was documented on 2/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/15/23 with zero (0) demerit for a superior classification. The Emergency Medical Care plan was posted and is current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space 3/4 (Rm, 119/122), the NC Pre-K children engaged in gross motor play on the playground. The children rode bikes, ran and played with sand. In space 5 (Rm 125) a group of one-year-old children engaged in free play. One (1) child’s diaper was changed, and the procedure was adequately followed. The other children explored the environment and washed other children on the playground. A group of two-year-old children from space 6 and 7 (Rm 201 and 204) played on the playground. The children rode riding toys and other accessories. In space 8 (Rm 308), a group of three-year-old children played with classroom materials during free play. The children built structures with blocks, created free art with brush paint. One (1) child rested on the child-size sofa in the library area. In Space 10 (Rm 314), a group of three-to-four-year-old children engaged in free play with magnetic tiles, brush paint, playdough, marker, sand, water and blocks. Thermometer was not in the refrigerator, but it was corrected during the visit. In space 12 (Rm 328), a group of one-year-old children engaged in gross motor play in the classroom. The children played with a climber and a tunnel. In space 13 (Rm 208), a group of infants explored the environment. One (1) child was held by a teacher, one (1) child was in a bouncer and the other children played with a beachball with another teacher. In space 14 (Rm207), a group of infants participated in reading time. The teacher read two (2) books to the children. One (1) child was falling asleep in the arm as the teacher read the books. Permission forms for diaper creams, over-the-counter lotions, lipbalms were monitored. All forms were valid. There is one (1) emergency medication maintained at this facility. The action plan and the medication authorization form were current. Today's lunch was beef taco, black beans and pineapple tidbits. Space 1, 2, 9, 11 were not in use during the visit. All existing staff files were monitored for criminal background letters, CPR/First Aid certificate and ITS/SIDS certificates. Three (3) new staff member’s files were monitored in full. Two (2) NC Pre-K children’s files were monitored due to annual compliance visit takes place during the summer. Dial-4 is used for Developmental Screening. Teeth exam, vision and hearing were included in physical exam. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was reviewed. The monitoring tool was reviewed by Dr. Barbra Jeffrey’s of Region A on 12/13/23. Two (2) children files were monitored today due to NC Pre-K classroom being closed during the last Annual Compliance visit. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. There was no thermometer in the refrigerator in space 10 (Room 314). 15A NCAC 18A .2806(j)(2) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete First Aid training before 12/18/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete CPR training before 12/18/23. .1102(d) Technical assistance was provided as follows: 601: Refrigerator temperature Refrigerator temperature must be maintained under forty-five (45) degree. Thermometer shall be placed in all refrigerators. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (f) All food shall be stored in a manner to protect it from dust, rodents, insects, drip, splash and other contamination. Raw meats, poultry, fish, shellfish and eggs shall be stored on shelving beneath and separate from other foods. The temperature of potentially hazardous food provided by the center shall be 45°F (7°C) or below, or 140°F (60°C) or above at all times, including field trips, catering events, outdoor service, except during necessary periods of preparation and service, and as otherwise provided in the Rules of this Section. 1048: First Aid 1049: CPR 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS Staff members shall obtain First aid and CPR certification within ninety(90) days of employment. First Aid and CPR training is provided by the campus security personnel at this facility. If, in any case, you are unable to complete the training within the agency, please contact other organizations, such as Hear Saver and Red Cross. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/20/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Rated License Cohort: Haywood Community College Regional Center for the Advancement of Children is in cohort one (1). Your prep-year is current through July 2024, and the assessment year will be July 2024 through June 2025. We have discussed prep-year assessment. Ms. Worley is planning to apply in April 2024 and wishes to go through the assessment in May 2024. Reminder: CPR/First Aid certificate for DW will expire on 3/30/24. Shelter-in-place is due this month. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556-9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 2/6/2024 Number Present: 75 Completed Date: 2/6/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 09:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site and/or electronically emailed to you. Today, Denise Worley, Administrator, accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today. Permit type – Five-star center license issued on 11/3/23. Special Services/Restrictions: daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 1/3/24. The last shelter-in-place drill was practiced on 11/30/23. The last playground inspection was documented on 2/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/15/23 with zero (0) demerit for a superior classification. The Emergency Medical Care plan was posted and is current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space 3/4 (Rm, 119/122), the NC Pre-K children engaged in gross motor play on the playground. The children rode bikes, ran and played with sand. In space 5 (Rm 125) a group of one-year-old children engaged in free play. One (1) child’s diaper was changed, and the procedure was adequately followed. The other children explored the environment and washed other children on the playground. A group of two-year-old children from space 6 and 7 (Rm 201 and 204) played on the playground. The children rode riding toys and other accessories. In space 8 (Rm 308), a group of three-year-old children played with classroom materials during free play. The children built structures with blocks, created free art with brush paint. One (1) child rested on the child-size sofa in the library area. In Space 10 (Rm 314), a group of three-to-four-year-old children engaged in free play with magnetic tiles, brush paint, playdough, marker, sand, water and blocks. Thermometer was not in the refrigerator, but it was corrected during the visit. In space 12 (Rm 328), a group of one-year-old children engaged in gross motor play in the classroom. The children played with a climber and a tunnel. In space 13 (Rm 208), a group of infants explored the environment. One (1) child was held by a teacher, one (1) child was in a bouncer and the other children played with a beachball with another teacher. In space 14 (Rm207), a group of infants participated in reading time. The teacher read two (2) books to the children. One (1) child was falling asleep in the arm as the teacher read the books. Permission forms for diaper creams, over-the-counter lotions, lipbalms were monitored. All forms were valid. There is one (1) emergency medication maintained at this facility. The action plan and the medication authorization form were current. Today's lunch was beef taco, black beans and pineapple tidbits. Space 1, 2, 9, 11 were not in use during the visit. All existing staff files were monitored for criminal background letters, CPR/First Aid certificate and ITS/SIDS certificates. Three (3) new staff member’s files were monitored in full. Two (2) NC Pre-K children’s files were monitored due to annual compliance visit takes place during the summer. Dial-4 is used for Developmental Screening. Teeth exam, vision and hearing were included in physical exam. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was reviewed. The monitoring tool was reviewed by Dr. Barbra Jeffrey’s of Region A on 12/13/23. Two (2) children files were monitored today due to NC Pre-K classroom being closed during the last Annual Compliance visit. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. There was no thermometer in the refrigerator in space 10 (Room 314). 15A NCAC 18A .2806(j)(2) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete First Aid training before 12/18/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete CPR training before 12/18/23. .1102(d) Technical assistance was provided as follows: 601: Refrigerator temperature Refrigerator temperature must be maintained under forty-five (45) degree. Thermometer shall be placed in all refrigerators. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (f) All food shall be stored in a manner to protect it from dust, rodents, insects, drip, splash and other contamination. Raw meats, poultry, fish, shellfish and eggs shall be stored on shelving beneath and separate from other foods. The temperature of potentially hazardous food provided by the center shall be 45°F (7°C) or below, or 140°F (60°C) or above at all times, including field trips, catering events, outdoor service, except during necessary periods of preparation and service, and as otherwise provided in the Rules of this Section. 1048: First Aid 1049: CPR 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS Staff members shall obtain First aid and CPR certification within ninety(90) days of employment. First Aid and CPR training is provided by the campus security personnel at this facility. If, in any case, you are unable to complete the training within the agency, please contact other organizations, such as Hear Saver and Red Cross. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/20/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Rated License Cohort: Haywood Community College Regional Center for the Advancement of Children is in cohort one (1). Your prep-year is current through July 2024, and the assessment year will be July 2024 through June 2025. We have discussed prep-year assessment. Ms. Worley is planning to apply in April 2024 and wishes to go through the assessment in May 2024. Reminder: CPR/First Aid certificate for DW will expire on 3/30/24. Shelter-in-place is due this month. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556-9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 2/6/2024 Number Present: 75 Completed Date: 2/6/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 09:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site and/or electronically emailed to you. Today, Denise Worley, Administrator, accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today. Permit type – Five-star center license issued on 11/3/23. Special Services/Restrictions: daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 1/3/24. The last shelter-in-place drill was practiced on 11/30/23. The last playground inspection was documented on 2/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/15/23 with zero (0) demerit for a superior classification. The Emergency Medical Care plan was posted and is current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space 3/4 (Rm, 119/122), the NC Pre-K children engaged in gross motor play on the playground. The children rode bikes, ran and played with sand. In space 5 (Rm 125) a group of one-year-old children engaged in free play. One (1) child’s diaper was changed, and the procedure was adequately followed. The other children explored the environment and washed other children on the playground. A group of two-year-old children from space 6 and 7 (Rm 201 and 204) played on the playground. The children rode riding toys and other accessories. In space 8 (Rm 308), a group of three-year-old children played with classroom materials during free play. The children built structures with blocks, created free art with brush paint. One (1) child rested on the child-size sofa in the library area. In Space 10 (Rm 314), a group of three-to-four-year-old children engaged in free play with magnetic tiles, brush paint, playdough, marker, sand, water and blocks. Thermometer was not in the refrigerator, but it was corrected during the visit. In space 12 (Rm 328), a group of one-year-old children engaged in gross motor play in the classroom. The children played with a climber and a tunnel. In space 13 (Rm 208), a group of infants explored the environment. One (1) child was held by a teacher, one (1) child was in a bouncer and the other children played with a beachball with another teacher. In space 14 (Rm207), a group of infants participated in reading time. The teacher read two (2) books to the children. One (1) child was falling asleep in the arm as the teacher read the books. Permission forms for diaper creams, over-the-counter lotions, lipbalms were monitored. All forms were valid. There is one (1) emergency medication maintained at this facility. The action plan and the medication authorization form were current. Today's lunch was beef taco, black beans and pineapple tidbits. Space 1, 2, 9, 11 were not in use during the visit. All existing staff files were monitored for criminal background letters, CPR/First Aid certificate and ITS/SIDS certificates. Three (3) new staff member’s files were monitored in full. Two (2) NC Pre-K children’s files were monitored due to annual compliance visit takes place during the summer. Dial-4 is used for Developmental Screening. Teeth exam, vision and hearing were included in physical exam. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was reviewed. The monitoring tool was reviewed by Dr. Barbra Jeffrey’s of Region A on 12/13/23. Two (2) children files were monitored today due to NC Pre-K classroom being closed during the last Annual Compliance visit. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. There was no thermometer in the refrigerator in space 10 (Room 314). 15A NCAC 18A .2806(j)(2) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete First Aid training before 12/18/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete CPR training before 12/18/23. .1102(d) Technical assistance was provided as follows: 601: Refrigerator temperature Refrigerator temperature must be maintained under forty-five (45) degree. Thermometer shall be placed in all refrigerators. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (f) All food shall be stored in a manner to protect it from dust, rodents, insects, drip, splash and other contamination. Raw meats, poultry, fish, shellfish and eggs shall be stored on shelving beneath and separate from other foods. The temperature of potentially hazardous food provided by the center shall be 45°F (7°C) or below, or 140°F (60°C) or above at all times, including field trips, catering events, outdoor service, except during necessary periods of preparation and service, and as otherwise provided in the Rules of this Section. 1048: First Aid 1049: CPR 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS Staff members shall obtain First aid and CPR certification within ninety(90) days of employment. First Aid and CPR training is provided by the campus security personnel at this facility. If, in any case, you are unable to complete the training within the agency, please contact other organizations, such as Hear Saver and Red Cross. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/20/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Rated License Cohort: Haywood Community College Regional Center for the Advancement of Children is in cohort one (1). Your prep-year is current through July 2024, and the assessment year will be July 2024 through June 2025. We have discussed prep-year assessment. Ms. Worley is planning to apply in April 2024 and wishes to go through the assessment in May 2024. Reminder: CPR/First Aid certificate for DW will expire on 3/30/24. Shelter-in-place is due this month. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556-9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 2/6/2024 Number Present: 75 Completed Date: 2/6/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 09:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site and/or electronically emailed to you. Today, Denise Worley, Administrator, accompanied me. The indoor and outdoor areas were monitored today, including but not limited to supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety (90) percent as of today. Permit type – Five-star center license issued on 11/3/23. Special Services/Restrictions: daytime care, meets enhanced space and reduced ratios. The last annual compliance visit was conducted on 8/11/23. The last fire drill was practiced on 1/3/24. The last shelter-in-place drill was practiced on 11/30/23. The last playground inspection was documented on 2/5/24. The last fire inspection was approved on 11/7/23. The last sanitation inspection was conducted on 12/15/23 with zero (0) demerit for a superior classification. The Emergency Medical Care plan was posted and is current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announced my presence and the purpose of the visit. In space 3/4 (Rm, 119/122), the NC Pre-K children engaged in gross motor play on the playground. The children rode bikes, ran and played with sand. In space 5 (Rm 125) a group of one-year-old children engaged in free play. One (1) child’s diaper was changed, and the procedure was adequately followed. The other children explored the environment and washed other children on the playground. A group of two-year-old children from space 6 and 7 (Rm 201 and 204) played on the playground. The children rode riding toys and other accessories. In space 8 (Rm 308), a group of three-year-old children played with classroom materials during free play. The children built structures with blocks, created free art with brush paint. One (1) child rested on the child-size sofa in the library area. In Space 10 (Rm 314), a group of three-to-four-year-old children engaged in free play with magnetic tiles, brush paint, playdough, marker, sand, water and blocks. Thermometer was not in the refrigerator, but it was corrected during the visit. In space 12 (Rm 328), a group of one-year-old children engaged in gross motor play in the classroom. The children played with a climber and a tunnel. In space 13 (Rm 208), a group of infants explored the environment. One (1) child was held by a teacher, one (1) child was in a bouncer and the other children played with a beachball with another teacher. In space 14 (Rm207), a group of infants participated in reading time. The teacher read two (2) books to the children. One (1) child was falling asleep in the arm as the teacher read the books. Permission forms for diaper creams, over-the-counter lotions, lipbalms were monitored. All forms were valid. There is one (1) emergency medication maintained at this facility. The action plan and the medication authorization form were current. Today's lunch was beef taco, black beans and pineapple tidbits. Space 1, 2, 9, 11 were not in use during the visit. All existing staff files were monitored for criminal background letters, CPR/First Aid certificate and ITS/SIDS certificates. Three (3) new staff member’s files were monitored in full. Two (2) NC Pre-K children’s files were monitored due to annual compliance visit takes place during the summer. Dial-4 is used for Developmental Screening. Teeth exam, vision and hearing were included in physical exam. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. The NC Pre-K Program Site Monitoring Tool was reviewed. The monitoring tool was reviewed by Dr. Barbra Jeffrey’s of Region A on 12/13/23. Two (2) children files were monitored today due to NC Pre-K classroom being closed during the last Annual Compliance visit. The classroom operates from 7:30 a.m. to 2:30 p.m. The following violations were documented during today’s visit: Violation Number Comment Rule 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. There was no thermometer in the refrigerator in space 10 (Room 314). 15A NCAC 18A .2806(j)(2) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete First Aid training before 12/18/23. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. The staff member hired on 9/19/23 did not complete CPR training before 12/18/23. .1102(d) Technical assistance was provided as follows: 601: Refrigerator temperature Refrigerator temperature must be maintained under forty-five (45) degree. Thermometer shall be placed in all refrigerators. 15A NCAC 18A .2806 FOOD STORAGE AND PROTECTION (f) All food shall be stored in a manner to protect it from dust, rodents, insects, drip, splash and other contamination. Raw meats, poultry, fish, shellfish and eggs shall be stored on shelving beneath and separate from other foods. The temperature of potentially hazardous food provided by the center shall be 45°F (7°C) or below, or 140°F (60°C) or above at all times, including field trips, catering events, outdoor service, except during necessary periods of preparation and service, and as otherwise provided in the Rules of this Section. 1048: First Aid 1049: CPR 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS Staff members shall obtain First aid and CPR certification within ninety(90) days of employment. First Aid and CPR training is provided by the campus security personnel at this facility. If, in any case, you are unable to complete the training within the agency, please contact other organizations, such as Hear Saver and Red Cross. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/ Corrective Action Plan: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 2/20/24. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Rated License Cohort: Haywood Community College Regional Center for the Advancement of Children is in cohort one (1). Your prep-year is current through July 2024, and the assessment year will be July 2024 through June 2025. We have discussed prep-year assessment. Ms. Worley is planning to apply in April 2024 and wishes to go through the assessment in May 2024. Reminder: CPR/First Aid certificate for DW will expire on 3/30/24. Shelter-in-place is due this month. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556-9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 9/28/2023 Number Present: 71 Completed Date: 9/28/2023 Age: From 0 To 5 Total Minutes: 175 Time In: 09:20 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during Administrative Action Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, Denise Worley, Administrator, was available during today’s visit. Limited Monitoring of Child Care requirements were conducted including staff qualification, special training, program record, approved space, permit restriction, storage of hazardous products and medication, staff/child ratios, group size and supervision. This is the last of Administrative Action follow-up visit. This facility operates with provisional License issued on 5/2/23 with restrictions: daytime care, meets enhanced ratios, space and reduced ratios. This facility’s requirements are met for NC Pre-K. Upon arrival, I announced my presence and the purpose of the visit. A walk-through of all licensed space was conducted. A group of four-to-five-year-old, NC Pre-K children for space #3/4, engaged in gross motor free play on the playground. Some children rode tricycles, some children observed a caterpillar, and the other children ran and played games with each other. Teachers were spread apart on the playground. The children from space #5, #6, #7, #12 were on the younger children’s playground. A group of one-to-two-year-old children and their four (4) teachers engaged in gross motor activities. Children played with riding toys, toy vehicles, balls, music instruments, and accessories. Teachers were spread on the playground. In space #13, a group of infants explored the environment. Some children crawls, some laydown/sat down and played with materials. One (1) child was fed a bottle while being held on a rocking chair. In space #14, a group of infants explored the environment and materials on the floor. Three (3) children sat/laid near the teacher and touched/chewed materials. Supervision and interactions were adequate. All teachers filled out fifteen-minute log sufficiently. The logs reflected how many children were under their care at each time. When some children were moved around due to staff shortage, the logs reflected the change. Three (3) new staff files were monitored in full, and four (4) existing staff members’ files were monitored partially. All other staff members have valid criminal background letters, CPR/First aid certificates and ITS/SIDS training certificate if required. Three (3) out of four (4) existing staff members completed CPR/First aid training on 8/14/23. The certificates have been requested from the trainer, but it has not been provided. One of four (4) existing staff members did renew the CPR/FA training on 3/21/23, but the certificate was not in the file. I have recovered the training certificate in the previous emails with Ms. Worley, and the certificate was shared with her via email. The staff member missed the scheduled training due to illness. Three (3) new staff members have required medical documentation, emergency information form, orientation information, criminal background qualifying letter. ABCMS system was reviewed for the three (3) new staff members, and their criminal background letters are valid. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member BC renewed the first aid training on 3/21/23, but the certificate was not maintained in the staff file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member BC renewed the CPR training on 3/21/23, but the certificate was not maintained in the staff file. .1102(d) Technical assistance was provided as follows: 1048: First Aid 1049: CPR All staff members shall complete CPR/First Aid within ninety (90) days of employment and keep the certificate valid. The certificate(s) shall be printed and maintained in staff file as soon as possible. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov Corrective Action Plan: Due to all violations corrected during the visit, you do not have to send me a letter of compliance unless you choose to. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/12/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Administrative Action: This is the last visit for the Administrative Action Provisional License issued on 5/2/23. After submitting documentation of your corrective actions to Bonnie Mathis, Licensing Supervisor, you will receive a closure letter and a new permit before 11/2/23. If you have any questions, please let me know. Rated License assessment: We discussed Rated License Assessment. This facility is in Cohort one (1). Ms. Worley is working with specialists from the Southwestern Child Development Commission to be ready for the prep-year assessment. The plan is to apply for the prep-year assessment in January. The education of staff members is a concern since there are many new and inexperienced staff members. Ms. Worley is planning to attend the informational webinar conducted on 10/3/23 to gain more information on CDA. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .1102 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 9/28/2023 Number Present: 71 Completed Date: 9/28/2023 Age: From 0 To 5 Total Minutes: 175 Time In: 09:20 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during Administrative Action Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, Denise Worley, Administrator, was available during today’s visit. Limited Monitoring of Child Care requirements were conducted including staff qualification, special training, program record, approved space, permit restriction, storage of hazardous products and medication, staff/child ratios, group size and supervision. This is the last of Administrative Action follow-up visit. This facility operates with provisional License issued on 5/2/23 with restrictions: daytime care, meets enhanced ratios, space and reduced ratios. This facility’s requirements are met for NC Pre-K. Upon arrival, I announced my presence and the purpose of the visit. A walk-through of all licensed space was conducted. A group of four-to-five-year-old, NC Pre-K children for space #3/4, engaged in gross motor free play on the playground. Some children rode tricycles, some children observed a caterpillar, and the other children ran and played games with each other. Teachers were spread apart on the playground. The children from space #5, #6, #7, #12 were on the younger children’s playground. A group of one-to-two-year-old children and their four (4) teachers engaged in gross motor activities. Children played with riding toys, toy vehicles, balls, music instruments, and accessories. Teachers were spread on the playground. In space #13, a group of infants explored the environment. Some children crawls, some laydown/sat down and played with materials. One (1) child was fed a bottle while being held on a rocking chair. In space #14, a group of infants explored the environment and materials on the floor. Three (3) children sat/laid near the teacher and touched/chewed materials. Supervision and interactions were adequate. All teachers filled out fifteen-minute log sufficiently. The logs reflected how many children were under their care at each time. When some children were moved around due to staff shortage, the logs reflected the change. Three (3) new staff files were monitored in full, and four (4) existing staff members’ files were monitored partially. All other staff members have valid criminal background letters, CPR/First aid certificates and ITS/SIDS training certificate if required. Three (3) out of four (4) existing staff members completed CPR/First aid training on 8/14/23. The certificates have been requested from the trainer, but it has not been provided. One of four (4) existing staff members did renew the CPR/FA training on 3/21/23, but the certificate was not in the file. I have recovered the training certificate in the previous emails with Ms. Worley, and the certificate was shared with her via email. The staff member missed the scheduled training due to illness. Three (3) new staff members have required medical documentation, emergency information form, orientation information, criminal background qualifying letter. ABCMS system was reviewed for the three (3) new staff members, and their criminal background letters are valid. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member BC renewed the first aid training on 3/21/23, but the certificate was not maintained in the staff file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member BC renewed the CPR training on 3/21/23, but the certificate was not maintained in the staff file. .1102(d) Technical assistance was provided as follows: 1048: First Aid 1049: CPR All staff members shall complete CPR/First Aid within ninety (90) days of employment and keep the certificate valid. The certificate(s) shall be printed and maintained in staff file as soon as possible. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov Corrective Action Plan: Due to all violations corrected during the visit, you do not have to send me a letter of compliance unless you choose to. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/12/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Administrative Action: This is the last visit for the Administrative Action Provisional License issued on 5/2/23. After submitting documentation of your corrective actions to Bonnie Mathis, Licensing Supervisor, you will receive a closure letter and a new permit before 11/2/23. If you have any questions, please let me know. Rated License assessment: We discussed Rated License Assessment. This facility is in Cohort one (1). Ms. Worley is working with specialists from the Southwestern Child Development Commission to be ready for the prep-year assessment. The plan is to apply for the prep-year assessment in January. The education of staff members is a concern since there are many new and inexperienced staff members. Ms. Worley is planning to attend the informational webinar conducted on 10/3/23 to gain more information on CDA. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 9/28/2023 Number Present: 71 Completed Date: 9/28/2023 Age: From 0 To 5 Total Minutes: 175 Time In: 09:20 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during Administrative Action Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, Denise Worley, Administrator, was available during today’s visit. Limited Monitoring of Child Care requirements were conducted including staff qualification, special training, program record, approved space, permit restriction, storage of hazardous products and medication, staff/child ratios, group size and supervision. This is the last of Administrative Action follow-up visit. This facility operates with provisional License issued on 5/2/23 with restrictions: daytime care, meets enhanced ratios, space and reduced ratios. This facility’s requirements are met for NC Pre-K. Upon arrival, I announced my presence and the purpose of the visit. A walk-through of all licensed space was conducted. A group of four-to-five-year-old, NC Pre-K children for space #3/4, engaged in gross motor free play on the playground. Some children rode tricycles, some children observed a caterpillar, and the other children ran and played games with each other. Teachers were spread apart on the playground. The children from space #5, #6, #7, #12 were on the younger children’s playground. A group of one-to-two-year-old children and their four (4) teachers engaged in gross motor activities. Children played with riding toys, toy vehicles, balls, music instruments, and accessories. Teachers were spread on the playground. In space #13, a group of infants explored the environment. Some children crawls, some laydown/sat down and played with materials. One (1) child was fed a bottle while being held on a rocking chair. In space #14, a group of infants explored the environment and materials on the floor. Three (3) children sat/laid near the teacher and touched/chewed materials. Supervision and interactions were adequate. All teachers filled out fifteen-minute log sufficiently. The logs reflected how many children were under their care at each time. When some children were moved around due to staff shortage, the logs reflected the change. Three (3) new staff files were monitored in full, and four (4) existing staff members’ files were monitored partially. All other staff members have valid criminal background letters, CPR/First aid certificates and ITS/SIDS training certificate if required. Three (3) out of four (4) existing staff members completed CPR/First aid training on 8/14/23. The certificates have been requested from the trainer, but it has not been provided. One of four (4) existing staff members did renew the CPR/FA training on 3/21/23, but the certificate was not in the file. I have recovered the training certificate in the previous emails with Ms. Worley, and the certificate was shared with her via email. The staff member missed the scheduled training due to illness. Three (3) new staff members have required medical documentation, emergency information form, orientation information, criminal background qualifying letter. ABCMS system was reviewed for the three (3) new staff members, and their criminal background letters are valid. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member BC renewed the first aid training on 3/21/23, but the certificate was not maintained in the staff file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member BC renewed the CPR training on 3/21/23, but the certificate was not maintained in the staff file. .1102(d) Technical assistance was provided as follows: 1048: First Aid 1049: CPR All staff members shall complete CPR/First Aid within ninety (90) days of employment and keep the certificate valid. The certificate(s) shall be printed and maintained in staff file as soon as possible. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov Corrective Action Plan: Due to all violations corrected during the visit, you do not have to send me a letter of compliance unless you choose to. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/12/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Administrative Action: This is the last visit for the Administrative Action Provisional License issued on 5/2/23. After submitting documentation of your corrective actions to Bonnie Mathis, Licensing Supervisor, you will receive a closure letter and a new permit before 11/2/23. If you have any questions, please let me know. Rated License assessment: We discussed Rated License Assessment. This facility is in Cohort one (1). Ms. Worley is working with specialists from the Southwestern Child Development Commission to be ready for the prep-year assessment. The plan is to apply for the prep-year assessment in January. The education of staff members is a concern since there are many new and inexperienced staff members. Ms. Worley is planning to attend the informational webinar conducted on 10/3/23 to gain more information on CDA. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 9/28/2023 Number Present: 71 Completed Date: 9/28/2023 Age: From 0 To 5 Total Minutes: 175 Time In: 09:20 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during Administrative Action Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, Denise Worley, Administrator, was available during today’s visit. Limited Monitoring of Child Care requirements were conducted including staff qualification, special training, program record, approved space, permit restriction, storage of hazardous products and medication, staff/child ratios, group size and supervision. This is the last of Administrative Action follow-up visit. This facility operates with provisional License issued on 5/2/23 with restrictions: daytime care, meets enhanced ratios, space and reduced ratios. This facility’s requirements are met for NC Pre-K. Upon arrival, I announced my presence and the purpose of the visit. A walk-through of all licensed space was conducted. A group of four-to-five-year-old, NC Pre-K children for space #3/4, engaged in gross motor free play on the playground. Some children rode tricycles, some children observed a caterpillar, and the other children ran and played games with each other. Teachers were spread apart on the playground. The children from space #5, #6, #7, #12 were on the younger children’s playground. A group of one-to-two-year-old children and their four (4) teachers engaged in gross motor activities. Children played with riding toys, toy vehicles, balls, music instruments, and accessories. Teachers were spread on the playground. In space #13, a group of infants explored the environment. Some children crawls, some laydown/sat down and played with materials. One (1) child was fed a bottle while being held on a rocking chair. In space #14, a group of infants explored the environment and materials on the floor. Three (3) children sat/laid near the teacher and touched/chewed materials. Supervision and interactions were adequate. All teachers filled out fifteen-minute log sufficiently. The logs reflected how many children were under their care at each time. When some children were moved around due to staff shortage, the logs reflected the change. Three (3) new staff files were monitored in full, and four (4) existing staff members’ files were monitored partially. All other staff members have valid criminal background letters, CPR/First aid certificates and ITS/SIDS training certificate if required. Three (3) out of four (4) existing staff members completed CPR/First aid training on 8/14/23. The certificates have been requested from the trainer, but it has not been provided. One of four (4) existing staff members did renew the CPR/FA training on 3/21/23, but the certificate was not in the file. I have recovered the training certificate in the previous emails with Ms. Worley, and the certificate was shared with her via email. The staff member missed the scheduled training due to illness. Three (3) new staff members have required medical documentation, emergency information form, orientation information, criminal background qualifying letter. ABCMS system was reviewed for the three (3) new staff members, and their criminal background letters are valid. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member BC renewed the first aid training on 3/21/23, but the certificate was not maintained in the staff file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member BC renewed the CPR training on 3/21/23, but the certificate was not maintained in the staff file. .1102(d) Technical assistance was provided as follows: 1048: First Aid 1049: CPR All staff members shall complete CPR/First Aid within ninety (90) days of employment and keep the certificate valid. The certificate(s) shall be printed and maintained in staff file as soon as possible. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov Corrective Action Plan: Due to all violations corrected during the visit, you do not have to send me a letter of compliance unless you choose to. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/12/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Administrative Action: This is the last visit for the Administrative Action Provisional License issued on 5/2/23. After submitting documentation of your corrective actions to Bonnie Mathis, Licensing Supervisor, you will receive a closure letter and a new permit before 11/2/23. If you have any questions, please let me know. Rated License assessment: We discussed Rated License Assessment. This facility is in Cohort one (1). Ms. Worley is working with specialists from the Southwestern Child Development Commission to be ready for the prep-year assessment. The plan is to apply for the prep-year assessment in January. The education of staff members is a concern since there are many new and inexperienced staff members. Ms. Worley is planning to attend the informational webinar conducted on 10/3/23 to gain more information on CDA. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 9/28/2023 Number Present: 71 Completed Date: 9/28/2023 Age: From 0 To 5 Total Minutes: 175 Time In: 09:20 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during Administrative Action Follow-up visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, Denise Worley, Administrator, was available during today’s visit. Limited Monitoring of Child Care requirements were conducted including staff qualification, special training, program record, approved space, permit restriction, storage of hazardous products and medication, staff/child ratios, group size and supervision. This is the last of Administrative Action follow-up visit. This facility operates with provisional License issued on 5/2/23 with restrictions: daytime care, meets enhanced ratios, space and reduced ratios. This facility’s requirements are met for NC Pre-K. Upon arrival, I announced my presence and the purpose of the visit. A walk-through of all licensed space was conducted. A group of four-to-five-year-old, NC Pre-K children for space #3/4, engaged in gross motor free play on the playground. Some children rode tricycles, some children observed a caterpillar, and the other children ran and played games with each other. Teachers were spread apart on the playground. The children from space #5, #6, #7, #12 were on the younger children’s playground. A group of one-to-two-year-old children and their four (4) teachers engaged in gross motor activities. Children played with riding toys, toy vehicles, balls, music instruments, and accessories. Teachers were spread on the playground. In space #13, a group of infants explored the environment. Some children crawls, some laydown/sat down and played with materials. One (1) child was fed a bottle while being held on a rocking chair. In space #14, a group of infants explored the environment and materials on the floor. Three (3) children sat/laid near the teacher and touched/chewed materials. Supervision and interactions were adequate. All teachers filled out fifteen-minute log sufficiently. The logs reflected how many children were under their care at each time. When some children were moved around due to staff shortage, the logs reflected the change. Three (3) new staff files were monitored in full, and four (4) existing staff members’ files were monitored partially. All other staff members have valid criminal background letters, CPR/First aid certificates and ITS/SIDS training certificate if required. Three (3) out of four (4) existing staff members completed CPR/First aid training on 8/14/23. The certificates have been requested from the trainer, but it has not been provided. One of four (4) existing staff members did renew the CPR/FA training on 3/21/23, but the certificate was not in the file. I have recovered the training certificate in the previous emails with Ms. Worley, and the certificate was shared with her via email. The staff member missed the scheduled training due to illness. Three (3) new staff members have required medical documentation, emergency information form, orientation information, criminal background qualifying letter. ABCMS system was reviewed for the three (3) new staff members, and their criminal background letters are valid. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The program does not provide transportation. The following violations were documented during today’s visit: Violation Number Comment Rule 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member BC renewed the first aid training on 3/21/23, but the certificate was not maintained in the staff file. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member BC renewed the CPR training on 3/21/23, but the certificate was not maintained in the staff file. .1102(d) Technical assistance was provided as follows: 1048: First Aid 1049: CPR All staff members shall complete CPR/First Aid within ninety (90) days of employment and keep the certificate valid. The certificate(s) shall be printed and maintained in staff file as soon as possible. (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov. (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov Corrective Action Plan: Due to all violations corrected during the visit, you do not have to send me a letter of compliance unless you choose to. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 10/12/23. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013 or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Administrative Action: This is the last visit for the Administrative Action Provisional License issued on 5/2/23. After submitting documentation of your corrective actions to Bonnie Mathis, Licensing Supervisor, you will receive a closure letter and a new permit before 11/2/23. If you have any questions, please let me know. Rated License assessment: We discussed Rated License Assessment. This facility is in Cohort one (1). Ms. Worley is working with specialists from the Southwestern Child Development Commission to be ready for the prep-year assessment. The plan is to apply for the prep-year assessment in January. The education of staff members is a concern since there are many new and inexperienced staff members. Ms. Worley is planning to attend the informational webinar conducted on 10/3/23 to gain more information on CDA. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0302 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0713 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: HAYWOOD COMMUNITY COLLEGE REGIONAL CENTER FOR THE Facility ID: 44000138 Consultant: KAORU EDDINS Operation Type: Center Case Number: Visit Date: 8/11/2023 Number Present: 52 Completed Date: 8/11/2023 Age: From 0 To 4 Total Minutes: 280 Time In: 09:20 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Kaoru Eddins, Child Care Consultant and also signed by Denise Worley, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Today, the Denise Worley, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was ninety-one (91) percentage as of 8/7/23. The North Carolina Secretary of State website was viewed prior to today’s visit and the Non-Profit corporation, Haywood Community College Foundation, Incorporated is current/active as of 8/7/23. Permit type – Provisional License issued on 5/2/23. Special Services/Restrictions – daytime care, meets enhanced space and ratios. Meets reduced ratios. The last annual compliance visit was conducted 8/24/22. The last fire drill was practiced 7/31/23. The last lockdown drill was practiced 4/27/23. The last playground inspection was documented on 7/18/23. The last fire inspection was approved on 10/13/22. The last sanitation inspection was conducted on 6/28/23 with four (4) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Creative Curriculum. Upon arrival, I announce my presence and the purpose of the visit. I observed children from three (3) classrooms combined on the playground. The children were from space # 5 (Rm, 125), space #7 (Room 204) and space # 12 (Rm 328). A group of one-to-three-year-old children engaged in free play on the playground using sand, shovels, bucket, musical instruments, push toys, riding toys, toy vehicles, and other accessories. Two (2) children, three (3) years of age were transferred to space #8 (308) during the visit. On the preschool playground, a group of three-to-four-year-old children from space # 8 (Rm308) had a water day. Children wore bathing suits and water shoes. A large sprinkler was used in the middle of the playground. In space #10 (Rm 314), a group of four to five-year-old children took a walk on campus. One (1) of the children’s parents participated with the child. In space #13 (Rm 208), four (4) infants played with materials on the floor. One (1) infant was asleep in the crib. The sleep chart was monitored and adequately logged. Bottles in the refrigerator were labeled with the date and initial, and feeding plans were signed by the parents and posted in the classroom. In space #8 (Rm 308), space #12 (Rm 328), and space #7(Rm 204), no hazardous materials were observed. The fridge temperature is under forty-five (45) degrees in both classrooms, lesson plan was dated for this week and posted. Children were on the playground. In space #7 (Rm 204), medications were monitored. One (1) emergency medication and many diaper creams and sunscreen were stored out of reach of children. Permission forms for creams and sunscreen were valid. The action plan for the emergency medication was also valid. In space #14 (Rm 207) two (2) infants were present. One (1) child was sleeping in the crib and the other child played with sensory toys on the floor. Lesson plans were posted and dated for this month. Dirty toys were in the sink. Permission forms for diaper creams were valid. In space #4 (Rm 125), children transitioned from free play to lunch. One (1) child was changed, and two (2) children played with puzzles and pop-up toys. Lunch was served and the menu was cheese toast, pinto beans, peaches, and milk. The kitchen was monitored and the items matched what was listed on the menu. The fridge temperatures were adequate. Space #1, 2, 3/4 6, 9, 11, were not in use during the visit. Supervision and interaction were adequate. Teachers were attentive to crying children and appropriate prompts were made to guide children. Teachers were spread apart on the playground and supervised children well. Head Count logs were maintained. Two (2) existing staff files were monitored in full, and five (5) staff files were monitored partially. Upon reviewing ABCMS for Criminal Background dates and status, all staff members currently qualify to work in child care as of 8/7/23. Nine (9) children’s files were monitored. The incident report, acknowledgment of receipt/discussion of prevention of shaken baby syndrome and abusive head trauma policy, operational policy, discipline policy, tobacco-free campus, safe sleep policy, and NC lay were present in all children’s files. The volunteer policy form was in the files as well. All other required documents, such as medical, immunization records, application, off-site premises form, and emergency information were included in the files. No violations were found. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 318 Children between 12 and 24 months of age were grouped with children 3 years of age or older. On younger children's playground, three (3) classrooms were combined. At the time of the visit, there were six (6) children, one (1) year of age from space #5 and #12, thirteen (13) children, two (2) years of age from space #7 and #12 and two (2) children, three (3) years of age from space #7 present. 10A NCAC 09 .0713(a)(6) 405 A child's hands were not washed after each diaper change. In space #5(Rm 125) a child's hands were not washing after diaper change. 15A NCAC 18A .2803(c)(2) 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. In space #5, children started lunch without washing hands. 15A NCAC 18A .2803(c) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the playground backpack for space #8(Rm 308), an inhaler for a child was not kept in original box with pharmacy label. .0803(2)(a) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. The last lockdown drill was conducted on 4/27/23. .0604(u);.0302(d)(8) 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. A staff member hired on 5/12/23 did not complete the training on or prior to 8/10/23. .1102(g) Technical assistance was provided as follows: 318: Children between 12-24 moths of age 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (6) except as provided in Subparagraph (2) of this Paragraph, children between the ages of 12 months and 24 months shall not be grouped with older children unless all children in the group are less than three years of age; (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; 405: Handwashing upon diaper changing Children’s hands shall be washed after each diaper change. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 608: Handwashing upon meal time Children hands shall be washed prior to eating. 15A NCAC 18A .2803 HANDWASHING (b) Children shall wash hands upon arrival at the child care center; after each diaper change or visit to the toilet; before eating meals or snacks; before and after water play; after outdoor activity.; and after handling animals or animal cages. Except for diapering and before eating meals or snacks, hand sanitizing products may be used in lieu of handwashing while children are outdoors if hands are washed upon returning indoors. 844: Medication in a original box Medications shall be stored in its original box. Prescriptions shall be labeled with pharmacy sticker with patient/doctor/pharmacy and instruction information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; 1811: Lockdown/shelter-in-place drill Lockdown or shelter-in-place drill is required every three (3) months. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (u) A "shelter in place drill" or "lockdown drill" as defined in 10A NCAC 09 .0102 shall be conducted at least every three months and records shall be maintained as required by 10A NCAC 09 .0302(d)(8) 1897: Recognizing the Responding to Suspicions of Child Maltreatment training. All new employees shall complete the training within ninety (90) days of employment. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (g) The child care administrator and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. This training shall count toward requirements set forth in Rule .1103 of this Section. Recognizing and Responding to Suspicions of Child Maltreatment training is available at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 8/25/23. Item 318 requires a follow-up visit. I will verify compliance on item 318 during the follow-up visit. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: kaoru.eddins@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Kaoru Eddins PO Box 795 Pisgah Forest, NC 28768 Please call me at 828-556-9013, or email kaoru.eddins@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: Administrative Action: The facility is under Administrative Action with Provisional License issued on 5/2/23. We discussed stipulation #2. I requested to see the signed acknowledgement for supervision rule review. I have reviewed forms. Most of the forms are dated on 5/10/23 with a few exceptions. We also discussed stipulation #3 on supervision policy. Revision of the policy was discussed during Administrative Action Follow-up visit on 7/24/23. We have discussed what changes will be made, and I verbally approved it during the visit today. The revision of staff handbook has been submitted to Haywood Community College HR department by Ms. Worley. When the revision is completed, please submit the revised supervision policy to me. Reminders: Lockdown/Shelter-in-place drill is due as soon as possible. Permission form for an inhaler in space #7 (Rm. 204) is not in file. Please ask JS’s parent/guardian to complete the permission form prior to administering the medication to the child. An inhaler in the backpack in space #8 (Rm 308) will expire in September, 2023. The action plan for the inhaler will expire on 8/24/23. If you have any questions or concerns regarding the Stabilization, Expansion and Access Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at kaoru.eddins@dhhs.nc.gov or 828.556.9013, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times