10A NCAC 09 .0803 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .1102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.1102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.1103 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.1104 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/4/2025 Number Present: 91 Completed Date: 9/4/2025 Age: From 0 To 4 Total Minutes: 405 Time In: 09:15 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 me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition, nap, and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-five percent (85%) as of 7/2/2025. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Play Center, Inc., is current/active as of 7/2/2025. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/18/2024. The last fire drill was practiced on 8/22/2025. The last lockdown drill was practiced on 8/28/2025. The previous emergency drill on 5/6/2025 was conducted late and was due by the end of April 2025. The drill prior to the 5/6/2025 drill was conducted on 1/15/2025. The last playground inspection was documented on 9/2/2025 The last fire inspection was approved on 8/5/2025. The last sanitation inspection was conducted on 8/11/2025 with six (6) demerits for a superior classification. The last lead water test was completed on 7/25/2023. The next testing is due on or before 7/25/2026. The facility was exempt from lead paint and asbestos testing due to providing the appropriate documentation to show all buildings were built after 1978 and 1988 to meet the building age exemption criteria per 10A NCAC 41C .1003. and 10A NCAC 41C.1004. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Explorations with Young Children A Curriculum from The Banks Street College of Education. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. Space # 1, the group of three- to- four- year-old children was indoors engaged in free play with legos, drawing, books, dramatic play, blocks, and block people. Space # 2, the group of two- to three-year-old children were nine (9) children were indoors engaged in free play with two (2) staff members and eight (8) children outdoors with one (1) staff member. The children indoors were engaged in free play with art and dramatic play. The children outdoors were engaged in gross motor play. While monitoring the medications, I observed one (1) emergency medication permission to administer medication not signed by the parents. One (1) emergency mediation permission to administer medication form expired 4/13/2025. Space #3, the group of two-year-old children half of the group was indoors using the restroom. The other half of the children were outdoors engaged in gross motor play. While monitoring the classroom, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Space # 4, the group of infant -and -one- year-old children were engaged in outdoor gross motor play with cars, balls, and digging toys. The staff members were sitting with the children engaged in play while actively supervising all the children. Space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play with balls, push car toys, and digging. The staff members were moving about the outdoor area. While monitoring indoors, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Space #6, the group of infants were engaged in exploring their environment, engaged in activity seat play, art in the highchair, and nap. One (1) staff member was in the floor with the children exploring their environment, and one (1) staff member was sitting with the children in the highchair doing art. While monitoring the indoor space, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Space #7, the group of infants were engaged in exploring the room, individual bottle feeding, highchair feeding, and nap. One (1) staff member was feeding the children baby food in the highchairs, one (1) staff member was in the floor bottle feeding two (2) children in a feeding chair, and one (1) staff member was conducting routine diaper changes. Lunch today consisted of chicken nuggets, carrots, peaches, and milk. The program does not provide transportation. All mediations were monitored. The outdoor environment was monitored. During nap time, the facility uses natural lighting and low-calming music. While going around to each classroom the administrator and I did discuss with staff if they see a child put the blanket over their face to ensure that they remove the blanket in order to see the child’s face. Staff and children’s files were monitored, and I observed staff member hired 6/13/2025 first two weeks six (6) clock hours were not completed during the first two weeks. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. Professional development plan on file is dated 8/11/2023, First Aid and CPR certification expired 5/2024. The staff member left on maternity leave in July of 2024 and returned to work sporadically in December 2024. The staff member continued to work sporadically from December 2024 to May 2025. Then returned to work regularly in June 2025 and July 2025. The staff member was planning to terminate their employment by the end of July 2025. 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 428 A current activity plan was not posted for each group of children for reference. Space #5, I observed the activity plan posted was dated 8/18-8/29. GS 110-91(12); .0508(a) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Space #3, one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. 15A NCAC 18A .2820(d) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. Space #2, one (1) emergency medication permission to administer medication not signed by the parents. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. 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. Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. .0803(12) 1041 Prior to employment a Criminal Background Check was not completed. Staff member A. Haefelia was on-site without completing a criminal background check prior to employment. G.S. 110-90.2(b) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024 .1102(d) 1052 Staff required to receive on-going training had not completed the required number of hours according to their education and experience. Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. .1103(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. .1101(a)(b) 1757 A valid qualification letter was not on file and available to review at the facility. Staff member A. Haefelia was on-site without a valid qualifying criminal background check on file for review. G.S. 110-90.2(b) & (d) & .2703(e) 1902 The professional development plan was not reviewed annually. Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. .1104 Technical assistance was provided as follows: Item 428- Space #5, I observed the activity plan posted was dated 8/18-8/29. When asked about the current activity plans, the staff member stated they were posted. I stated the plans posted are from the previous week. The staff member printed the current activity plans and posted them during the visit. Rule Reference: G.S. 110-91(12);.0508(a) Item 841- one (1) medicated ChapStick was located on the shelf in the restroom area unlocked. We discussed that the medicated chapstick would need to move the chapstick to locked storage. The staff member moved it to the lock box that contains the children’s sunscreen and other medications. Rule Reference: 15A NCAC 18A.2820(d) Item 842- Space #2, one (1) emergency medication permission to administer medication not signed by the parents. We discussed to review the permission to administer medication forms prior to allowing the medication to remain on site to ensure all areas are completed and the parent has signed the form giving authorization to administer the medication. Rule Reference: 10A NCAC 09 .0803(1)(a)&(b) Item 847- Space #6, one diaper cream permission to administer medication form was missing the authorized dates to administer the medication. We discussed when a medication form is completed to ensure that the parent completes the dates to administer the medication. Rule Reference: 10A NCAC 09 .0803(4)&(6-9) Item 849- Space #2, one (1) emergency mediation permission to administer medication form expired 4/13/2025. We discussed when reviewing the medications monthly to ensure staff check the medication authorization dates to administer. The administrator discussed with the staff member during the visit and asked the staff member to get the parent to complete the dates during pickup today. Rule Reference: 10A NCAC 09 Item 1041- Staff member A. Haefelia was on-site without a valid qualifying criminal background check. We discussed that compensated staff members who are awaiting a valid criminal background check cannot be on-site until the state has issued a qualifying letter. If a person is counted as a volunteer this means that the person is not being compensated by the facility. Rule reference: G.S. 110-90.2(b) Item 1048- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09.1102(c) Item 1049- Staff member hired 7/15/2022, First Aid certification was not renewed prior to the expiration date. The certification on file expired 5/2024. We discussed documenting when each staff members card expires and scheduling their recertification training prior to the expiration date. Rule Reference: 10A NCAC 09 .1102(d) Item 1052- Staff member hired on 7/15/2022 on-going hours were due to be completed by 7/15/2025. The staff member completed 2.5 hours as the staff member thought she was going to terminate employment prior to July. We discussed when reviewing staff files to ensure that all staff currently employed complete the required number of on-going training hours per their education. Rule Reference: 10A NCAC 09.1103(a) Item 1067- First two weeks of orientation was not completed for staff member AD hired 6/13/2025. The Documentation of Orientation on file documented three (3) hours instead of the required six (6) hours. We discussed when completing the documentation of orientation for the first two weeks to ensure that each staff member receives the required six (6) clock hours of training in the required topics. Rule Reference: 10A NCAC 09.1102(a)(b) Item 1757- Staff member A. Haefelia was on-site without a valid qualifying criminal background check of file for review. We discussed that compensated staff members must have a valid qualifying criminal background check letter on file for review on their first day of employment. Rule reference: G.S. 110-90.2(b) & (d) & .2703(e) Item 1902- Staff member hired 7/15/2022, professional development plans was not reviewed annually. The last professional development plan review was dated 8/11/2023. We discussed preplanning a day to complete all professional development plans for staff members that are currently employed. Rule Reference: 10A NCAC 09.1104 Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 9/18/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -We discussed what it means to be uncompensated provider and a volunteer, and what this means for potential employment. 10A NCAC 09 .0102 (55) "Uncompensated provider" means a person who works in a child care facility and is counted in staff/child ratio or has unsupervised contact with children, but who is not monetarily compensated by the facility. An uncompensated provider must be at least 18 years of age and literate. (56) "Volunteer" means a person who works in a child care facility and is not counted in staff/child ratio, does not have unsupervised contact with children, and is not monetarily compensated by the facility. A person who is at least 13 years of age, but less than 16 years age, may work on a volunteer basis, as long as he or she is supervised by and works with a staff person who is at least 21 years of age and meets staff qualification requirements. -We discussed the new QRIS pathways to the stars. I asked the provider to begin looking at which pathway they want to pursue. During the next unannounced visit, we will discuss which pathway they have chosen and begin planning and discussing next steps. Today, I encouraged the provider to visit the Divisions website https://ncchildcare.ncdhhs.gov/ to access the Quality Rating Improvement System (QRIS) Modernization page to review each pathway and the supporting resources. - DCDEE has added a new training module about Child Development on the DCDEE Moodle Learning Platform. This is the first of several planned modules to support orientation and the health and safety training requirements. This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID is needed to access the Child Development Module. If you do not have an NCID, visit MYNCID.nc.gov to register for a free NCID account. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@ dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0803 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.0902 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09.1103 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 3/21/2025 Number Present: 77 Completed Date: 3/21/2025 Age: From 0 To 5 Total Minutes: 220 Time In: 09:20 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable child care requirements for a routine unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator during the visit. A signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, accompanied me today during the walk through and was available to assist with questions. The program’s annual compliance visit was conducted on 9/18/2024. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last fire drill was practiced on 2/26/2025. The last emergency drill, lockdown drill, was practiced on 1/15/2025. The last fire inspection was approved on 8/8/2024. The program’s most recent sanitation inspection was completed on 8/5/2024, with six (6) demerits. The Emergency Medical Care Plan is current and posted. The facility closed on 9/27/2024 due to Tropical Storm Helene and re-opened after Tropical Storm Helene on 10/7/2024. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four to five year-old children was indoors engaged free play with free art, music, measuring, magnetic tiles, and blocks. In space # 2, the group of three- to four-year-old children were engaged water color painting a rainbow and preparing to transition outside for gross motor play. While monitoring the medication, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. One (1) sunscreen on site with no permission to administer medication form. In space #3, the group of two to three year-old children were engaged in free play with baby dolls, music, and mazes. In space # 4, the group of one year-old children were at the table drinking water. After drinking water, the children engaged in block play. Two (2) one year olds were visiting from space #6 & #7 in order to maintain staff/child ratio. In space # 5, the group of one to two year old children were engaged in washing hands after play dough play and free play. In space #6, the group of infants were exploring the environment and one (1) infant was sleeping in their crib. While monitoring the classroom space and medications, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. When I asked the teacher about it, she stated that the parent completed the form on 3/19/2025 but she did not know the exact end date to stop administering the medication. The staff added the child’s name, medication name, and expiration date during the visit, but she did not add the end date. She will need to speak with the parent. Two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. In space #7, the group of infants and one year old children three (3) children were sleeping in the crib and one (1) was in the high chair eating lunch. Lunch today consisted of sloppy joes, cheesy potatoes, peaches, bread, and milk. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. .0902(a) 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In space #2, one (1) sunscreen on site with no permission to administer medication form. 10A NCAC 09 .0803(1)(a & b) 847 Parent's medication authorization did not include required information. In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. 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 #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. .0803(12) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. .1103(b) Technical assistance was provided as follows: Item 541 In space #6, two (2) infant feeding plans were not signed by the parents and dated when the center received the plan. We discussed that infant feeding plans are to be reviewed and signed by the parent and the center the day they are received. Rule Reference: 10A NCAC 09.0902(a) Item 842 In space #2, one (1) sunscreen on site with no permission to administer medication form. We discussed when a parent brings in a medication, the parent must complete the permission to administer medication form in order to authorize the facility to administer the medication. Rule Reference: 10A NCAC 09.0803(2)(a) Item 847 In space #6, one (1) prescription medication was missing the child’s name, medication name, expiration date, and the date to stop administering the medication. We discussed that the facility will need to review the form prior to sending the medication to the classroom for use to ensure all the required information is completed. Rule Reference: 10A NCAC 09.0803(4)(6-9) Item 849 In space #2, one (1) diaper cream permission to administer medication form expired 11/28/2024 and one (1) bug spray permission to administer medication form expired 8/21/2024. One sunscreen expired 10/2024 and one (1) Aquaphor expired 1/2025. When discussed it is best practice to review the medication forms and medications monthly to ensure that the medications and medication forms are valid to use. Rule Reference: 10A NCAC 09.0803(12) Item 1899 Staff member CC one (1) health and safety training was not completed within five (5) years of the previously completed training. The training was completed on 6/19/2019 and was due to be completed by 6/19/2024. We discussed that the health and safety training topics are due within five (5) years of the date the training topic was previously completed. The staff member will need to complete the training within two (2) weeks. Rule Reference: 10A NCAC 09.1103(b) Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/4/2025. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Outdoors prior to infants going outside, staff will need to conduct a check and remove any small rocks from the play area. Public comment is open for the new Quality Rating Improvement System (QRIS) pathways to the stars till April 4, 2025. I strongly encourage you to review the resources and informational page on the Divisions website. Lead Paint and Asbestos Testing- In April 2023, North Carolina enacted final rules 10A NCAC 41C .1001-1007 requiring all public schools and child care facilities to: Test for lead in drinking/cooking water (.1005 and .2816), Identify lead-based paint hazards (.1004), Identify asbestos hazards (.1003), Mitigate or restrict access to any identified hazards. Testing is required to be completed by May 31, 2025. New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS110-91 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/18/2024 Number Present: 91 Completed Date: 9/18/2024 Age: From 0 To 4 Total Minutes: 305 Time In: 09:40 AM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. Vanessa Gilliam, Administrator, was on-site and available during the visit. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The center’s compliance history was reviewed with the operator. The program’s compliance history was eighty-one percent (81%) as of 8/23/2024. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter, Inc, is Current-Active as of 9/18/2024. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – First shift, meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 9/26/2023. The last fire drill was practiced on 8/29/2024. The last lockdown drill was practiced on 6/28/2024. The last playground inspection was documented on 8/16/2024. The last fire inspection was approved on 8/8/2024. The last sanitation inspection was conducted on 8/5/2024 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current. The Emergency Preparedness and Response plans is current and up to date. The approved curriculum for four-year-old children is Banks Street. During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- year-old children was indoors engaged in story time on the carpet. After story time, the teacher lead a sign language lesson, and a apple stacking activity. While monitoring the indoor space, two (2) electrical outlets were observed uncovered above the children’s hand washing sink. The staff corrected this during the visit. In space # 2, the group of three- to four-year-old children were engaged in group time. The teacher was reading the story Caps for Sale. In space #3, the group of two year-old children half of the group was indoors using the restroom and routine diaper change. The other half of the group was outdoors engaged in gross motor play. In space # 4, the group of one year-old children were engaged in music and movement. Children were able to continue with free play if they did not want to participate in music and movement. In space # 5, the group of one to two year old children were engaged in outdoor gross motor play with cars, slide, painting corn under the covered area, and digging. In space #6, the group of infants were engaged in floor play and individual feeding. Six (6) infants were on the floor engaged in play with rattles, and blocks, and one (1) infant was in the high chair drinking a bottle. The two (2) staff members were meeting the individual needs of the children. While monitoring the indoor space, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups during the visit. In space #7, the group of infants were engaged in rest time and a routine diaper change. The two (2) staff members were meeting the individual needs of the children. Lunch today consisted of black beans, corn, oranges, bread, and milk. Today, I monitored twelve (12) staff files and ten (10) children’s files. The program does not provide transportation. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. 15A NCAC 18A .2804(d) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. 10A NCAC 09 .0604(c) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. .0701(a) 1067 Each new employee did not complete, within the first two weeks of employment, six clock hours of training in required topic areas. Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. .1101(a)(b) 1320 Children's records that include an application for enrollment, medical and immunization records, and permission to seek emergency medical care was not on file for each child. Child enrolled on 8/12/2024 did not have a medical report on file for review. GS 110-91(1);.0302(d)(2); .0304(g) 1321 Medical exam or health assessment record was not on file before or within 30 days after admission. Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024 GS110-91(1) 1323 Each child was not immunized as per Article 6 of Chapter 130A and an immunization record was not on file before or within 30 days after admission Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. 10A NCAC 09 .0302(d)(2) Technical assistance was provided as follows: Item #533 In space #6, four (4) sippy cups were observed labeled with the child’s name but was not dated in the refrigerator. The staff added the date to the sippy cups. Rule Reference .2804(d) We discussed the need to remind parent to date the sippy cups and if staff notice that the sippy cups or bottles are not dated to add the date when placing them in the refrigerator. Item #812 In space # 1, two (2) electrical outlets were uncovered above the children’s hand washing sink. The staff corrected this during the visit. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (c) When not in use, electrical outlets and power strips located in space used by children shall have safety outlets or be covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. We discussed conducting a daily classroom check to ensure that all outlets are covered with a safety cover. Item #1034 One (1) staff member health questionnaire on file was dated 8/27/2022 and was not updated. The administrator stated that all staff completed this on 8/9/2024 and must have misplaced the staff members updated form. The staff member updated the health questionnaire during the visit. Rule Reference: .0701 (a) We discussed after the staff update the health questionnaire forms to create a filing system to help keep up with what documents need to be filed. Item #1067 Two (2) staff members Documentation of Orientation training topic Prevention and Control of infectious disease, including immunizations was blank on the documentation form. The administrator stated that this training was completed but forgot to write it down. The administrator corrected this during the visit. Rule reference: .1101 (a) (b) We discussed upon completion of orientation documenting the training date on the Documentation of Orientation form. Item #1320 Child enrolled on 8/12/2024 did not have a medical report on file for review. The administrator stated that she has been working with this family to get a medical report on file. The administrator contacted the parent again during the visit to request the medical report. The parent has contacted the doctors office and they stated that they need documents signed before faxing the medical report to the facility. Rule Reference: GS 110-91(1) Item #1321 Child enrolled on 7/29/2024 medical report was not submitted within thirty (30) days of enrollment. The medical report on file was dated 8/30/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. Item #1323 Child enrolled on 7/29/2024 immunizations was not submitted within thirty (30) days of enrollment. The immunizations on file was dated 8/31/2024. Rule Reference: GS 110-91 (1) We discussed the need to use the Children’s File Checklist to assist with tracking when each document is due. 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 10/2/2024. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: -Hold harmless has been extended until the new QRIS is implemented (SB 425). This means the cohort model is no longer valid. Providers who were in cohort 1 and the prep assessment was conducted can use the score for the rated license process until 6/30/2025. Those who were in cohort 2 and 3 can voluntarily apply to begin the rated license process. -We reviewed and discussed the storage of items with heating elements. Rule Reference 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (e) All electrical appliances shall be used only in accordance with the manufacturer's instructions. For appliances with heating elements, such as bottle warmers, crock pots, irons, coffee pots, or curling irons, neither the appliance nor any cord shall be accessible to preschool-age children. -Reminder Blue Lizard sunscreen in space #3 medication form will expire on 9/30/2024. -We discussed that you and the staff will need to keep an eye on the openings at the base of the fence on the preschool playground. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify a DCDEE representative may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any monitoring visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@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: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0607 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0608 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 4/4/2024 Number Present: 100 Completed Date: 4/4/2024 Age: From 0 To 5 Total Minutes: 270 Time In: 10:45 AM Time Out: 03:15 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 your program for compliance with applicable child care requirements for a routine unannounced visit. Upon arrival, the purpose of today’s visit was reviewed with you, Vanessa Gilliam, Administrator. Your program currently operates with a Four (4) Star Rated License, issued 8/12/2021. The permit restrictions were in compliance including Meets enhanced ratios, meets enhanced space. Vanessa Gilliam, Administrator, was available to assist with questions. The program’s annual compliance visit was conducted on 9/26/2023. The following items were monitored today: Supervision Staff / Child Ratio CPR / First Aid Special Training CBC Qualification ITS – SIDS Emergency Medical Care Plan Administration of Medication Storage of Hazardous Products Storage of Medication General Safety Discipline Adequate / Approved Space Program Records License Posted Permit Restrictions During today’s visit, I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space # 1, the group of four- to five-year-old children half of the group was indoors engaged in free play with the teacher. The other half of the group was outdoors engaged in gross motor play with the lead teacher. In space # 2, the group of three- to four-year-old children were engaged in free play with the puzzles, dress-up, and blocks. After free choice center play, the children cleaned up and prepared for lunch. In space #3, the group of two- to three-year-old children were coming in from gross motor play and washing hands to prepare for lunch. In space # 4, the group of one- to two-year-old children were preparing for lunch by washing hands. Once at the table, the staff served the children their lunch. After lunch, the children transitioned to nap time. In space # 5, the group of two year old children were eating lunch. After lunch, the children washed hands and transitioned to nap time. Child EB Auvi-Q was not in the original container with the pharmacy label. The administrator text the mother to request the original container with the pharmacy label. In space #6, the group of infants and one year old children three (3) were engaged in play on the floor and five (5) were sleeping. The two (2) staff members were meeting the individual needs of the children. Child DM infant feeding plan was missing the parent signature. Child RB buttpaste expired 3/2020. The administrator removed it from the classroom space to store until the parent arrives. In space #7, the group of infants to one year old children two (2) were engaged in play on the floor, and three (3) were in their cribs resting. The staff was rubbing a child’s back as they rested in the crib and actively supervising the children. The lunch today was spaghetti, salad, strawberries, and milk. The last fire drill was practiced on 3/25/2024. The last emergency drill, shelter in place, was practiced on 3/26/2024. The last fire inspection was approved on 8/28/23. The program’s most recent sanitation inspection was completed on 9/26/2023, with six (6) demerits. The Emergency Medical Care Plan is posted and was updated in 9/19/2023. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Special Training including Health and Safety Training and Criminal Background Checks. There is five (5) new staff member since the last annual compliance visit. The staff and training worksheet was completed for the new staff member files that were monitored. Staff member JH substitute shaken baby and abusive head trauma policy was not reviewed prior to caring for children, and documentation of review of the emergency medical care plan and emergency preparedness and response plan was not on file for review. The following violations of child care requirements were observed today: Violation Number Comment Rule 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. In space #6 child DM feeding plan did not contain the parents signature. .0902(a) 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 #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. .0803(12) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. 10A NCAC 09 .0802(a) 1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. .0607(g) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. .0608(d)(1-4) 1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. 10A NCAC 09 .0803(2)(b)(i-v) Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license could be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by 4/18/2024. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Technical Assistance for Correction Plan: Item #541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. -In space #6 child DM feeding plan did not contain the parents signature. I recommend staff reviewing the forms to ensure the parents signature is completed on the form. Item #862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (a) Each child care center shall have a written plan that sets forth the steps to follow in the event of a child medical emergency. The plan shall be reviewed with all staff annually and whenever the plan is revised. This plan shall give the procedures to be followed to ensure that any child who becomes ill or is injured and requires medical attention while in care at the center receives appropriate medical attention. The following information shall be included in the center's emergency medical care plan: (1) The name of the person and at least one alternate, responsible for carrying out that plan of action, ensuring that appropriate medical care is given, and determining which of the following is needed: (A) first aid given at the center for an injury or illness needing only minimal attention; and (B) calling 911 in accordance with CPR or First Aid training recommendations. (2) The name of the person and one alternate, at the center responsible for: (A) ensuring that the signed authorization described in Paragraph (d) of this Rule is taken with the ill or injured child to the medical facility; (B) accompanying the ill or injured child to the medical facility; (C) notifying a child's parents or emergency contact person about the illness or injury and where the child has been taken for treatment; (D) obtaining substitute staff, if needed, to maintain required staff/child ratio and adequate supervision of children who remain in the center; and (3) A statement giving the location of the telephone located on the premises available for use in case of emergency. A telephone located in an office in the center that is sometimes locked during the time the children are present shall not be designated for use in an emergency. - Substitute staff member JH 11/14/23 documentation of review of the EMC plan was not on file for review. I recommend reviewing the EMC the first day they work on-site at the child care facility. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. -In space #6, child RB buttpaste expired 3/2020. The administrator removed the paste during the visit. I recommend having staff review the medication forms and medications to look closely at expiration dates monthly. Item #1826 Substitutes and volunteers counted in ratio were not informed of the center's EPR Plan and its location. Documentation of this notice was not maintained on file or in a file designated for emergency preparedness and response plan documents. 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (g) All substitutes and volunteers counted in ratio shall be informed of the child care center's Emergency Preparedness and Response Plan and its location. Documentation of this notice shall be maintained in the individual personnel files or in a file designated for emergency preparedness and response plan documents. - Substitute staff member JH 11/14/23 documentation of the notice of the EPR plan and it’s location was not on file for review. I recommend reviewing the EPR plan the first day of work and have the staff sign off on a statement for documentation to have on file. Item #1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (d) Within 30 days of adopting the policy, the child care center shall review the policy with existing staff members who provide care for children up to five years of age. Each child care center shall review the policy with new staff members prior to the individual providing care to children. The acknowledgement of this review shall contain: (1) the individual’s name; (2) the date the center’s policy was given and explained to the individual; (3) the individual’s signature; and (4) the date the individual signed the acknowledgment. The child care center shall retain the acknowledgement in the staff member’s file. - Substitute staff member JH 11/14/23 Prevention of Shaken Baby Syndrome and Abusive Head Trauma was not reviewed with the staff prior to caring for children and a signed acknowledgement was not on file for review. I recommend having a substitute packet with a copy of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy to review with substitutes on the first day of work. Item #1879 Prescribed medicines, that are pharmaceutical samples, was not stored in the manufacturers original packaging, was not labeled with the child's name, and/or written instructions did not include the required information. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; - Child EB Auvi-Q was not in it’s original container with the pharmacy label. The administrator contacted the parent via text message to request the original container with the pharmacy label. I suggest when parents bring in prescription medications to ensure that the medication is in the original container with the pharmacy label prior to sending to the classroom for use. Consultation: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. - Before infants go outdoors staff need to conduct a playground check to remove any small rocks or any potential choking hazards. - Potting soil should be stored up five (5) feet until ready to use. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment! You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Challenging behaviors helpline can be reached at 1-888-600-1685 Option 1. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was left on-site with you. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0304 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0514 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0801 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: NESSA'S YOUNG'UNS NATURAL PLAY CENTER II Facility ID: 45000409 Consultant: KARLA TERRY Operation Type: Center Case Number: Visit Date: 9/26/2023 Number Present: 92 Completed Date: 9/26/2023 Age: From 0 To 5 Total Minutes: 340 Time In: 09:30 AM Time Out: 03:10 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Karla Terry, Child Care Consultant and also signed by Vanessa Gilliam, Administrator, during the visit. An electronic signed copy of the visit summary was electronically emailed to you. Vanessa Gilliam, Administrator accompanied me today. 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 percentage (91%) as of 9/25/2023. The North Carolina Secretary of State website was viewed prior to today’s visit and the Business Corporation, Nessa’s Young’uns Natural Playcenter Inc., is current/active as of 9/25/2023. Permit type – Four (4) Star Rated License, issued 8/12/2021. Special Services/Restrictions – Meets enhanced ratios, meets enhanced space. The last annual compliance visit was conducted on 10/3/2022. The last fire drill was practiced on 8/8/2023. The last shelter-in-place drill was practiced on 6/15/2023. The last playground inspection was documented on 9/25/2023. The last fire inspection was approved on 8/28/2023. The last sanitation inspection was conducted on 5/18/2023 with six (6) demerits for a superior classification. The Emergency Medical Care plan was posted and current as of 9/19/2023. The Emergency Preparedness and Response plans was updated as of 8/9/2023 and reviewed with staff. The approved curriculum for four-year-old children is Banks Street. Upon arrival, I introduced myself to the Administrator. I observed children in both the indoor and outdoor learning environments and found supervision and staff/child ratios to be in compliance. In space #6, the group of infants were one (1) infant was engaged in free play on the floor, one (1) infant was being held, one (1) infant was being fed in the high chair, and two (2) infants were sleeping. The staff member was meeting the individual needs of the children. One (1) child was asleep in their crib. In space #7, the group of infants were engaged in free play tummy time, two (2) child were asleep, and one (1) child was having a diaper change. The staff were meeting the individual needs of each child. In space # 4, the group of one year old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space # 5, the group of one- to two-year-old children were engaged in outdoor gross motor play and transitioning indoors to wash hands and begin routine diaper changing. In space #3, the group of two- to three-year-old children were engaged in outdoor gross motor play. In space # 2, the group of three year old children were engaged in outdoor gross motor play digging in the sand, and sliding. In space # 1, the group of four- to five-year-old children were engaged in digging in the sand, and sliding. All staff interactions were positive and nurturing. Supervision was developmentally appropriate. 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. All medications were monitored during today’s visit. There are twenty-six (26) of staff members. I monitored three (3) existing staff files and nine (9) new staff members. The staff and training worksheet was received prior to today’s visit by Vanessa Gilliam via email. There are one hundred six (106) children enrolled. I monitored ten (10) of children’s files. 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 #6, child JS feeding plan was not signed and dated by the parent. .0902(a) 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 #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. .0803(12) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .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 members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. .1102(d) 1232 Each employee's personnel file did not contain an annual staff evaluation and a staff development plan. Staff member BT hired 9/17/21 file did not contain a current staff evaluation. 10A NCAC 09 .0514(f) 1303 Application was not signed by the parent. Child FB enrolled 5/7/2020 application was not signed by the parent. 10A NCAC 09 .0801(a) 1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. Child MA enrolled 9/20/21 emergency information was not updated at least annually. .0802(c) Technical assistance was provided as follows: Item 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. 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. - In space #6, child JS feeding plan was not signed and dated by the parent. Item #849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (12) Any medication remaining after the course of treatment is completed, after authorization is withdrawn or after authorization has expired shall be returned to the child's parents. Any medication the parent fails to retrieve within 72 hours of completion of treatment, or withdrawal of authorization, shall be discarded. - In space #3, child LB Ventolin inhaler permission to administer medication form expired on 9/20/2023. Item #1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (c) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in First Aid appropriate to the ages of children in care. The training shall be completed by June 30, 2018, or for new staff hired on or after September 1, 2017, training must be completed within 90 days of employment. Distance learning shall not be permitted for First Aid training. At all times when children are in care at least one staff member present must have successfully completed First Aid training, as evidenced by a certificate or card from an approved training organization. First Aid training shall be renewed on or before expiration of the certification. "Successfully completed" is defined as demonstrating competency, as evaluated by the instructor. Verification of each required staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. 10A NCAC 09 .1102 HEALTH AND SAFETY TRAINING REQUIREMENTS (d) All staff who provide direct care or accompany children when they are off premises shall successfully complete certification in a cardiopulmonary resuscitation (CPR) course appropriate to the ages of children in care. At all times when children are in care one staff member present must have successfully completed CPR training. The training shall be completed by June 30, 2018 or for new staff hired on or after September 1, 2017 training must be completed within 90 days of employment. Distance learning shall not be permitted for CPR training. CPR training shall be renewed on or before the expiration of the certification. Verification of each staff member's completion of this course from an approved training organization shall be maintained in the staff member's file in the center. The Division shall post a list of approved training organizations on its website at http://ncchildcare.nc.gov/providers/pv_sn2_ov_pd.asp. - Staff members KE hired 6/5/23, AH hired 6/12/23, KD hired 4/24/23, did not complete First Aid training within the first ninety (90) days. Item #1232 Each employee’s personnel file did not contain an annual staff evaluation and a staff development plan. 10A NCAC 09 .0514 OPERATIONAL AND PERSONNEL POLICIES (f) In addition to all records required in Rule .0302(d) of this Chapter, each employee's personnel file shall contain an annual staff evaluation and staff development plan. - Staff member BT hired 9/17/21 file did not contain a current staff evaluation. Item #1303 Application was not signed by the parent. 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (a) Each child in care shall have an individual application for enrollment completed and signed by the child's parent, as defined in 10A NCAC 09 .0102. The completed, signed application shall be on file in the center on the first day the child attends and shall include the following information: (1) emergency medical information as set forth in Rule .0802(c) of this Section; (2) the child's full name and the name the child is to be called; (3) the child's date of birth; (4) any allergies and the symptoms and type of response required for allergic reactions; (5) any health care needs or concerns, symptoms of and the type of response required for these health care needs or concerns; (6) fears or behavior characteristics that the child has; and (7) the names of individuals to whom the center may release the child, as authorized by the person who signs the application. - Child FB enrolled 5/7/2020 application was not signed by the parent. Item #1311 Emergency medical care information was not on file in the center on the child's first day of attendance and/or was not updated as changes occurred or at least annually for each child. 10A NCAC 09 .0802 EMERGENCY MEDICAL CARE (c) Emergency medical care information shall be on file for each child. That information shall include: (1) the name, address, and telephone number of the parent or other person to be contacted in case of an emergency; (2) the responsible party's choice of health care professional; (3) any chronic illness and any medication taken for that illness; and (4) any other information that has a direct bearing on ensuring safe medical treatment for the child. This emergency medical care information shall be on file in the center on the child's first day of attendance and shall be updated as changes occur and at least annually. - Child MA enrolled 9/20/21 emergency information was not updated at least annually. 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 10/10/2023. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: karla.terry@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Karla Terry PO Box 552 Ellenboro, NC 28040 Please call me at 828-200-9952, or email karla.terry@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt is within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Consultation is provided as follows: Today, we discussed the following: - We discussed that you are a part of Cohort 3 for rated license reassessments. The program’s year of preparation will begin 7/1/2025 and end 6/30/2026. The assessment year will begin 7/1/2026 and end 6/30/2027. We discussed that each staff member will need to update their WORKS account to reflect their most recently completed education. Also, be sure to take advantage of the preparation year assessment. If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify 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 karla.terry@dhhs.nc.gov or 828-200-9952, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times