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Home › NC › Hayesville › Tiny Toes Learning Center Hayesville LLC
6 Cold Branch RD, Hayesville NC 28904 · License #22000028 · Center · Child Care Center
Not published by the state. Owners can add hours via profile claim.
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10A NCAC 09 .0302 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: Visit Date: 6/9/2026 Number Present: 17 Completed Date: 6/9/2026 Age: From 0 To 3 Total Minutes: 170 Time In: 09:25 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action final notice that was issued to the facility on 3/4/2026. A computerized generated report of today’s visit was completed, reviewed with you and signed by me, Bridget Owen Child Care Consultant and also signed by Lily Coffey, Administrator. A signed copy of the visit summary was left on site for you. Lily Coffey, Administrator, was observed providing care in Space #2A, the classroom serving infants and one-year-old children and was available to assist with answering questions during the visit. Ms. Coffey was relieved by staff/child ratio responsibilities when another teacher transitioned from Space #1 to cover the classroom. Upon arrival, the administrative action final notice, cover letter, and provisional license were posted at the entry where it could be viewed by parents and visitors. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (85%) as of 06/08/2026. The following was monitored during the visit, including, but not limited to: Supervision of children; Staff/child ratio; Discipline/Nurture Care of Children; Group size; Licensed capacity; Permit restriction; CPR/First Aid training; ITS-SIDS training; and new staff files. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action was issued on 1/23/26. A final notice administrative action was issued on 3/4/2026. An intent to change ownership was received from Ms. Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The administrative action was reviewed with the administrator on 4/22/2026. The Corrective Action Plan (CAP) was monitored for compliance as follows: Item #1 – This item is not in compliance as violations were documented during today’s visit. Item #2- Operator has not completed and returned the statement of understanding. Failure to complete the CAP will result in a revocation of the license. On 3/27/26, the operator provided a written statement that Tiny Toes Learning Center Hayesville LLC will not be reinstated. Staff/child ratios was as follows: Space #1 – two (2) staff and eight (8) children three (3) years of age. Space # 2A- one (1) staff and four (4) children ages infant through one year. Space # 2B- one (1) staff and five (5) children ages one through two years. The group of children three years of age was observed engaged in a variety of age-appropriate learning and play activities. Children participated in free-choice experiences and interacted positively with peers and staff. The group of children, one through two years of age was observed engaged in free-play activities and exploring the learning environment. Children moved freely throughout the room and participated in age-appropriate play experiences. The group of children zero through one year of age was observed engaged in free-play activities and sensory exploration. Infants moved freely throughout the room according to their developmental abilities and interacted with caregivers and materials provided in the environment. Staff were observed providing nurturing, attentive, care to the children. Supervision was adequate. Staff files were monitored for current CBC, FA/CPR, and ITS SIDS Training as applicable. One new staff file (A. Coffey) was monitored with a start date of 5/27/2026. One new substitute staff file (A. Lee) was monitored with a start date of 4/17/2026. No children’s files were monitored during the visit. The following violations were documented during today’s visit: Violation Number Comment Rule 125 Daily records of arrival and departure times for children at the center were not maintained as children arrive and depart and/or were not made available for review.One child was not signed in. 10A NCAC 09 .0302(d)(4) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). 10A NCAC 09 .0802(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A new staff member hired on 4/17/2026 did not have a health assessment on file for review. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. 10A NCAC 09 .0514(g) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). .0607(f) 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. A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. .0608(d)(1-4) Technical assistance was provided as follows: Item #125 – Daily Sign-In Sheet One child was not signed in. This was corrected during the visit. To achieve compliance: Ensure that each child is signed in upon arrival each day and that attendance records are reviewed regularly for accuracy and completeness. Item #825 – Emergency Medical Care Plan (EMC) A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). To achieve compliance: Ensure all newly hired staff review the facility's Emergency Medical Care Plan and maintain documentation of the review in the staff file. Item #1032 – Staff Health Assessment A new substitute staff member hired on 4/17/2026 did not have a health assessment on file for review. To achieve compliance: Obtain and maintain a completed health assessment for all staff members in accordance with licensing requirements. Item #1033 – Staff TB Skin Test/Questionnaire A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. To achieve compliance: Obtain and maintain current TB documentation for all staff members as required by licensing regulations. Item #1045 – Staff Orientation A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. To achieve compliance: Ensure all newly hired staff complete orientation and maintain documentation verifying completion in the staff file. Item #1233 – Staff Job Description A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. To achieve compliance: Provide each staff member with a written job description and maintain signed documentation acknowledging receipt in the staff file. Item #1825 – Emergency Preparedness and Response Plan (EPR) Review A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). To achieve compliance: Ensure all staff review the facility's Emergency Preparedness and Response Plan and maintain documentation of the review in the staff file. Item #1874 – Shaken Baby Syndrome Receipt A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. To achieve compliance: Ensure all required staff receive Shaken Baby Syndrome training/information and maintain signed documentation of receipt in the staff file. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 06/23/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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: Ownership Change We discussed you have signed lease agreement with Clay County, and you sent a copy to Monica Houck, Lead Consultant. You are waiting on the fire inspection. You have tentatively planned to closed July 6-10 for sanitation inspection (tentatively) and other ownership changes. We discussed that you have scheduled FA/CPR for A. Lee and A. Coffey for June 22, 2026. We discussed that Maltreatment training is due on or before 7/16/2026 for A. Lee and 8/25/2026 for A. Coffey. We discuss the LC Criminal Background qualifying letter will expire on 10/21/2026. Criminal Background Check every 5 years A criminal background check must be completed every five years. If an applicant changes employment while their qualification letter is valid and 180 days have not passed since employment in child care, the applicant must present a copy of the letter to the new employer to be kept on file. DCDEE recommends that applicants not let their criminal background check expire, so applicants should renew prior to the expiration date of the CBC letter. An individual may have their criminal background recheck completed as early as six months prior to the expiration date that is noted on the qualification letter. If an applicant has not been employed in child care within the last 180 days, a new application must be completed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/ If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Generated from this facility's specific inspection record
Data synced from North Carolina's child care licensing agency on Jul 9, 2026 · Report an error
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0514 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: Visit Date: 6/9/2026 Number Present: 17 Completed Date: 6/9/2026 Age: From 0 To 3 Total Minutes: 170 Time In: 09:25 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action final notice that was issued to the facility on 3/4/2026. A computerized generated report of today’s visit was completed, reviewed with you and signed by me, Bridget Owen Child Care Consultant and also signed by Lily Coffey, Administrator. A signed copy of the visit summary was left on site for you. Lily Coffey, Administrator, was observed providing care in Space #2A, the classroom serving infants and one-year-old children and was available to assist with answering questions during the visit. Ms. Coffey was relieved by staff/child ratio responsibilities when another teacher transitioned from Space #1 to cover the classroom. Upon arrival, the administrative action final notice, cover letter, and provisional license were posted at the entry where it could be viewed by parents and visitors. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (85%) as of 06/08/2026. The following was monitored during the visit, including, but not limited to: Supervision of children; Staff/child ratio; Discipline/Nurture Care of Children; Group size; Licensed capacity; Permit restriction; CPR/First Aid training; ITS-SIDS training; and new staff files. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action was issued on 1/23/26. A final notice administrative action was issued on 3/4/2026. An intent to change ownership was received from Ms. Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The administrative action was reviewed with the administrator on 4/22/2026. The Corrective Action Plan (CAP) was monitored for compliance as follows: Item #1 – This item is not in compliance as violations were documented during today’s visit. Item #2- Operator has not completed and returned the statement of understanding. Failure to complete the CAP will result in a revocation of the license. On 3/27/26, the operator provided a written statement that Tiny Toes Learning Center Hayesville LLC will not be reinstated. Staff/child ratios was as follows: Space #1 – two (2) staff and eight (8) children three (3) years of age. Space # 2A- one (1) staff and four (4) children ages infant through one year. Space # 2B- one (1) staff and five (5) children ages one through two years. The group of children three years of age was observed engaged in a variety of age-appropriate learning and play activities. Children participated in free-choice experiences and interacted positively with peers and staff. The group of children, one through two years of age was observed engaged in free-play activities and exploring the learning environment. Children moved freely throughout the room and participated in age-appropriate play experiences. The group of children zero through one year of age was observed engaged in free-play activities and sensory exploration. Infants moved freely throughout the room according to their developmental abilities and interacted with caregivers and materials provided in the environment. Staff were observed providing nurturing, attentive, care to the children. Supervision was adequate. Staff files were monitored for current CBC, FA/CPR, and ITS SIDS Training as applicable. One new staff file (A. Coffey) was monitored with a start date of 5/27/2026. One new substitute staff file (A. Lee) was monitored with a start date of 4/17/2026. No children’s files were monitored during the visit. The following violations were documented during today’s visit: Violation Number Comment Rule 125 Daily records of arrival and departure times for children at the center were not maintained as children arrive and depart and/or were not made available for review.One child was not signed in. 10A NCAC 09 .0302(d)(4) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). 10A NCAC 09 .0802(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A new staff member hired on 4/17/2026 did not have a health assessment on file for review. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. 10A NCAC 09 .0514(g) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). .0607(f) 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. A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. .0608(d)(1-4) Technical assistance was provided as follows: Item #125 – Daily Sign-In Sheet One child was not signed in. This was corrected during the visit. To achieve compliance: Ensure that each child is signed in upon arrival each day and that attendance records are reviewed regularly for accuracy and completeness. Item #825 – Emergency Medical Care Plan (EMC) A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). To achieve compliance: Ensure all newly hired staff review the facility's Emergency Medical Care Plan and maintain documentation of the review in the staff file. Item #1032 – Staff Health Assessment A new substitute staff member hired on 4/17/2026 did not have a health assessment on file for review. To achieve compliance: Obtain and maintain a completed health assessment for all staff members in accordance with licensing requirements. Item #1033 – Staff TB Skin Test/Questionnaire A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. To achieve compliance: Obtain and maintain current TB documentation for all staff members as required by licensing regulations. Item #1045 – Staff Orientation A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. To achieve compliance: Ensure all newly hired staff complete orientation and maintain documentation verifying completion in the staff file. Item #1233 – Staff Job Description A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. To achieve compliance: Provide each staff member with a written job description and maintain signed documentation acknowledging receipt in the staff file. Item #1825 – Emergency Preparedness and Response Plan (EPR) Review A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). To achieve compliance: Ensure all staff review the facility's Emergency Preparedness and Response Plan and maintain documentation of the review in the staff file. Item #1874 – Shaken Baby Syndrome Receipt A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. To achieve compliance: Ensure all required staff receive Shaken Baby Syndrome training/information and maintain signed documentation of receipt in the staff file. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 06/23/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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: Ownership Change We discussed you have signed lease agreement with Clay County, and you sent a copy to Monica Houck, Lead Consultant. You are waiting on the fire inspection. You have tentatively planned to closed July 6-10 for sanitation inspection (tentatively) and other ownership changes. We discussed that you have scheduled FA/CPR for A. Lee and A. Coffey for June 22, 2026. We discussed that Maltreatment training is due on or before 7/16/2026 for A. Lee and 8/25/2026 for A. Coffey. We discuss the LC Criminal Background qualifying letter will expire on 10/21/2026. Criminal Background Check every 5 years A criminal background check must be completed every five years. If an applicant changes employment while their qualification letter is valid and 180 days have not passed since employment in child care, the applicant must present a copy of the letter to the new employer to be kept on file. DCDEE recommends that applicants not let their criminal background check expire, so applicants should renew prior to the expiration date of the CBC letter. An individual may have their criminal background recheck completed as early as six months prior to the expiration date that is noted on the qualification letter. If an applicant has not been employed in child care within the last 180 days, a new application must be completed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/ If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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 .0701 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: Visit Date: 6/9/2026 Number Present: 17 Completed Date: 6/9/2026 Age: From 0 To 3 Total Minutes: 170 Time In: 09:25 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action final notice that was issued to the facility on 3/4/2026. A computerized generated report of today’s visit was completed, reviewed with you and signed by me, Bridget Owen Child Care Consultant and also signed by Lily Coffey, Administrator. A signed copy of the visit summary was left on site for you. Lily Coffey, Administrator, was observed providing care in Space #2A, the classroom serving infants and one-year-old children and was available to assist with answering questions during the visit. Ms. Coffey was relieved by staff/child ratio responsibilities when another teacher transitioned from Space #1 to cover the classroom. Upon arrival, the administrative action final notice, cover letter, and provisional license were posted at the entry where it could be viewed by parents and visitors. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (85%) as of 06/08/2026. The following was monitored during the visit, including, but not limited to: Supervision of children; Staff/child ratio; Discipline/Nurture Care of Children; Group size; Licensed capacity; Permit restriction; CPR/First Aid training; ITS-SIDS training; and new staff files. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action was issued on 1/23/26. A final notice administrative action was issued on 3/4/2026. An intent to change ownership was received from Ms. Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The administrative action was reviewed with the administrator on 4/22/2026. The Corrective Action Plan (CAP) was monitored for compliance as follows: Item #1 – This item is not in compliance as violations were documented during today’s visit. Item #2- Operator has not completed and returned the statement of understanding. Failure to complete the CAP will result in a revocation of the license. On 3/27/26, the operator provided a written statement that Tiny Toes Learning Center Hayesville LLC will not be reinstated. Staff/child ratios was as follows: Space #1 – two (2) staff and eight (8) children three (3) years of age. Space # 2A- one (1) staff and four (4) children ages infant through one year. Space # 2B- one (1) staff and five (5) children ages one through two years. The group of children three years of age was observed engaged in a variety of age-appropriate learning and play activities. Children participated in free-choice experiences and interacted positively with peers and staff. The group of children, one through two years of age was observed engaged in free-play activities and exploring the learning environment. Children moved freely throughout the room and participated in age-appropriate play experiences. The group of children zero through one year of age was observed engaged in free-play activities and sensory exploration. Infants moved freely throughout the room according to their developmental abilities and interacted with caregivers and materials provided in the environment. Staff were observed providing nurturing, attentive, care to the children. Supervision was adequate. Staff files were monitored for current CBC, FA/CPR, and ITS SIDS Training as applicable. One new staff file (A. Coffey) was monitored with a start date of 5/27/2026. One new substitute staff file (A. Lee) was monitored with a start date of 4/17/2026. No children’s files were monitored during the visit. The following violations were documented during today’s visit: Violation Number Comment Rule 125 Daily records of arrival and departure times for children at the center were not maintained as children arrive and depart and/or were not made available for review.One child was not signed in. 10A NCAC 09 .0302(d)(4) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). 10A NCAC 09 .0802(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A new staff member hired on 4/17/2026 did not have a health assessment on file for review. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. 10A NCAC 09 .0514(g) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). .0607(f) 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. A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. .0608(d)(1-4) Technical assistance was provided as follows: Item #125 – Daily Sign-In Sheet One child was not signed in. This was corrected during the visit. To achieve compliance: Ensure that each child is signed in upon arrival each day and that attendance records are reviewed regularly for accuracy and completeness. Item #825 – Emergency Medical Care Plan (EMC) A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). To achieve compliance: Ensure all newly hired staff review the facility's Emergency Medical Care Plan and maintain documentation of the review in the staff file. Item #1032 – Staff Health Assessment A new substitute staff member hired on 4/17/2026 did not have a health assessment on file for review. To achieve compliance: Obtain and maintain a completed health assessment for all staff members in accordance with licensing requirements. Item #1033 – Staff TB Skin Test/Questionnaire A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. To achieve compliance: Obtain and maintain current TB documentation for all staff members as required by licensing regulations. Item #1045 – Staff Orientation A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. To achieve compliance: Ensure all newly hired staff complete orientation and maintain documentation verifying completion in the staff file. Item #1233 – Staff Job Description A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. To achieve compliance: Provide each staff member with a written job description and maintain signed documentation acknowledging receipt in the staff file. Item #1825 – Emergency Preparedness and Response Plan (EPR) Review A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). To achieve compliance: Ensure all staff review the facility's Emergency Preparedness and Response Plan and maintain documentation of the review in the staff file. Item #1874 – Shaken Baby Syndrome Receipt A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. To achieve compliance: Ensure all required staff receive Shaken Baby Syndrome training/information and maintain signed documentation of receipt in the staff file. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 06/23/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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: Ownership Change We discussed you have signed lease agreement with Clay County, and you sent a copy to Monica Houck, Lead Consultant. You are waiting on the fire inspection. You have tentatively planned to closed July 6-10 for sanitation inspection (tentatively) and other ownership changes. We discussed that you have scheduled FA/CPR for A. Lee and A. Coffey for June 22, 2026. We discussed that Maltreatment training is due on or before 7/16/2026 for A. Lee and 8/25/2026 for A. Coffey. We discuss the LC Criminal Background qualifying letter will expire on 10/21/2026. Criminal Background Check every 5 years A criminal background check must be completed every five years. If an applicant changes employment while their qualification letter is valid and 180 days have not passed since employment in child care, the applicant must present a copy of the letter to the new employer to be kept on file. DCDEE recommends that applicants not let their criminal background check expire, so applicants should renew prior to the expiration date of the CBC letter. An individual may have their criminal background recheck completed as early as six months prior to the expiration date that is noted on the qualification letter. If an applicant has not been employed in child care within the last 180 days, a new application must be completed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/ If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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 .0802 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: Visit Date: 6/9/2026 Number Present: 17 Completed Date: 6/9/2026 Age: From 0 To 3 Total Minutes: 170 Time In: 09:25 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action final notice that was issued to the facility on 3/4/2026. A computerized generated report of today’s visit was completed, reviewed with you and signed by me, Bridget Owen Child Care Consultant and also signed by Lily Coffey, Administrator. A signed copy of the visit summary was left on site for you. Lily Coffey, Administrator, was observed providing care in Space #2A, the classroom serving infants and one-year-old children and was available to assist with answering questions during the visit. Ms. Coffey was relieved by staff/child ratio responsibilities when another teacher transitioned from Space #1 to cover the classroom. Upon arrival, the administrative action final notice, cover letter, and provisional license were posted at the entry where it could be viewed by parents and visitors. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (85%) as of 06/08/2026. The following was monitored during the visit, including, but not limited to: Supervision of children; Staff/child ratio; Discipline/Nurture Care of Children; Group size; Licensed capacity; Permit restriction; CPR/First Aid training; ITS-SIDS training; and new staff files. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action was issued on 1/23/26. A final notice administrative action was issued on 3/4/2026. An intent to change ownership was received from Ms. Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The administrative action was reviewed with the administrator on 4/22/2026. The Corrective Action Plan (CAP) was monitored for compliance as follows: Item #1 – This item is not in compliance as violations were documented during today’s visit. Item #2- Operator has not completed and returned the statement of understanding. Failure to complete the CAP will result in a revocation of the license. On 3/27/26, the operator provided a written statement that Tiny Toes Learning Center Hayesville LLC will not be reinstated. Staff/child ratios was as follows: Space #1 – two (2) staff and eight (8) children three (3) years of age. Space # 2A- one (1) staff and four (4) children ages infant through one year. Space # 2B- one (1) staff and five (5) children ages one through two years. The group of children three years of age was observed engaged in a variety of age-appropriate learning and play activities. Children participated in free-choice experiences and interacted positively with peers and staff. The group of children, one through two years of age was observed engaged in free-play activities and exploring the learning environment. Children moved freely throughout the room and participated in age-appropriate play experiences. The group of children zero through one year of age was observed engaged in free-play activities and sensory exploration. Infants moved freely throughout the room according to their developmental abilities and interacted with caregivers and materials provided in the environment. Staff were observed providing nurturing, attentive, care to the children. Supervision was adequate. Staff files were monitored for current CBC, FA/CPR, and ITS SIDS Training as applicable. One new staff file (A. Coffey) was monitored with a start date of 5/27/2026. One new substitute staff file (A. Lee) was monitored with a start date of 4/17/2026. No children’s files were monitored during the visit. The following violations were documented during today’s visit: Violation Number Comment Rule 125 Daily records of arrival and departure times for children at the center were not maintained as children arrive and depart and/or were not made available for review.One child was not signed in. 10A NCAC 09 .0302(d)(4) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). 10A NCAC 09 .0802(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A new staff member hired on 4/17/2026 did not have a health assessment on file for review. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. 10A NCAC 09 .0514(g) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). .0607(f) 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. A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. .0608(d)(1-4) Technical assistance was provided as follows: Item #125 – Daily Sign-In Sheet One child was not signed in. This was corrected during the visit. To achieve compliance: Ensure that each child is signed in upon arrival each day and that attendance records are reviewed regularly for accuracy and completeness. Item #825 – Emergency Medical Care Plan (EMC) A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). To achieve compliance: Ensure all newly hired staff review the facility's Emergency Medical Care Plan and maintain documentation of the review in the staff file. Item #1032 – Staff Health Assessment A new substitute staff member hired on 4/17/2026 did not have a health assessment on file for review. To achieve compliance: Obtain and maintain a completed health assessment for all staff members in accordance with licensing requirements. Item #1033 – Staff TB Skin Test/Questionnaire A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. To achieve compliance: Obtain and maintain current TB documentation for all staff members as required by licensing regulations. Item #1045 – Staff Orientation A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. To achieve compliance: Ensure all newly hired staff complete orientation and maintain documentation verifying completion in the staff file. Item #1233 – Staff Job Description A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. To achieve compliance: Provide each staff member with a written job description and maintain signed documentation acknowledging receipt in the staff file. Item #1825 – Emergency Preparedness and Response Plan (EPR) Review A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). To achieve compliance: Ensure all staff review the facility's Emergency Preparedness and Response Plan and maintain documentation of the review in the staff file. Item #1874 – Shaken Baby Syndrome Receipt A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. To achieve compliance: Ensure all required staff receive Shaken Baby Syndrome training/information and maintain signed documentation of receipt in the staff file. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 06/23/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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: Ownership Change We discussed you have signed lease agreement with Clay County, and you sent a copy to Monica Houck, Lead Consultant. You are waiting on the fire inspection. You have tentatively planned to closed July 6-10 for sanitation inspection (tentatively) and other ownership changes. We discussed that you have scheduled FA/CPR for A. Lee and A. Coffey for June 22, 2026. We discussed that Maltreatment training is due on or before 7/16/2026 for A. Lee and 8/25/2026 for A. Coffey. We discuss the LC Criminal Background qualifying letter will expire on 10/21/2026. Criminal Background Check every 5 years A criminal background check must be completed every five years. If an applicant changes employment while their qualification letter is valid and 180 days have not passed since employment in child care, the applicant must present a copy of the letter to the new employer to be kept on file. DCDEE recommends that applicants not let their criminal background check expire, so applicants should renew prior to the expiration date of the CBC letter. An individual may have their criminal background recheck completed as early as six months prior to the expiration date that is noted on the qualification letter. If an applicant has not been employed in child care within the last 180 days, a new application must be completed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/ If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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.
NC GS 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: Visit Date: 6/9/2026 Number Present: 17 Completed Date: 6/9/2026 Age: From 0 To 3 Total Minutes: 170 Time In: 09:25 AM Time Out: 12:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action final notice that was issued to the facility on 3/4/2026. A computerized generated report of today’s visit was completed, reviewed with you and signed by me, Bridget Owen Child Care Consultant and also signed by Lily Coffey, Administrator. A signed copy of the visit summary was left on site for you. Lily Coffey, Administrator, was observed providing care in Space #2A, the classroom serving infants and one-year-old children and was available to assist with answering questions during the visit. Ms. Coffey was relieved by staff/child ratio responsibilities when another teacher transitioned from Space #1 to cover the classroom. Upon arrival, the administrative action final notice, cover letter, and provisional license were posted at the entry where it could be viewed by parents and visitors. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (85%) as of 06/08/2026. The following was monitored during the visit, including, but not limited to: Supervision of children; Staff/child ratio; Discipline/Nurture Care of Children; Group size; Licensed capacity; Permit restriction; CPR/First Aid training; ITS-SIDS training; and new staff files. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action was issued on 1/23/26. A final notice administrative action was issued on 3/4/2026. An intent to change ownership was received from Ms. Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The administrative action was reviewed with the administrator on 4/22/2026. The Corrective Action Plan (CAP) was monitored for compliance as follows: Item #1 – This item is not in compliance as violations were documented during today’s visit. Item #2- Operator has not completed and returned the statement of understanding. Failure to complete the CAP will result in a revocation of the license. On 3/27/26, the operator provided a written statement that Tiny Toes Learning Center Hayesville LLC will not be reinstated. Staff/child ratios was as follows: Space #1 – two (2) staff and eight (8) children three (3) years of age. Space # 2A- one (1) staff and four (4) children ages infant through one year. Space # 2B- one (1) staff and five (5) children ages one through two years. The group of children three years of age was observed engaged in a variety of age-appropriate learning and play activities. Children participated in free-choice experiences and interacted positively with peers and staff. The group of children, one through two years of age was observed engaged in free-play activities and exploring the learning environment. Children moved freely throughout the room and participated in age-appropriate play experiences. The group of children zero through one year of age was observed engaged in free-play activities and sensory exploration. Infants moved freely throughout the room according to their developmental abilities and interacted with caregivers and materials provided in the environment. Staff were observed providing nurturing, attentive, care to the children. Supervision was adequate. Staff files were monitored for current CBC, FA/CPR, and ITS SIDS Training as applicable. One new staff file (A. Coffey) was monitored with a start date of 5/27/2026. One new substitute staff file (A. Lee) was monitored with a start date of 4/17/2026. No children’s files were monitored during the visit. The following violations were documented during today’s visit: Violation Number Comment Rule 125 Daily records of arrival and departure times for children at the center were not maintained as children arrive and depart and/or were not made available for review.One child was not signed in. 10A NCAC 09 .0302(d)(4) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). 10A NCAC 09 .0802(a) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. A new staff member hired on 4/17/2026 did not have a health assessment on file for review. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. 10A NCAC 09 .0514(g) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). .0607(f) 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. A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. .0608(d)(1-4) Technical assistance was provided as follows: Item #125 – Daily Sign-In Sheet One child was not signed in. This was corrected during the visit. To achieve compliance: Ensure that each child is signed in upon arrival each day and that attendance records are reviewed regularly for accuracy and completeness. Item #825 – Emergency Medical Care Plan (EMC) A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Medical Care Plan (EMC). To achieve compliance: Ensure all newly hired staff review the facility's Emergency Medical Care Plan and maintain documentation of the review in the staff file. Item #1032 – Staff Health Assessment A new substitute staff member hired on 4/17/2026 did not have a health assessment on file for review. To achieve compliance: Obtain and maintain a completed health assessment for all staff members in accordance with licensing requirements. Item #1033 – Staff TB Skin Test/Questionnaire A new substitute staff member hired on 4/17/2026 did not have documentation of a TB skin test or TB risk assessment on file for review. To achieve compliance: Obtain and maintain current TB documentation for all staff members as required by licensing regulations. Item #1045 – Staff Orientation A new substitute staff member hired on 4/17/2026 did not have orientation documentation on file for review. To achieve compliance: Ensure all newly hired staff complete orientation and maintain documentation verifying completion in the staff file. Item #1233 – Staff Job Description A new substitute staff member hired on 4/17/2026 did not have documentation acknowledging receipt of a job description on file for review. To achieve compliance: Provide each staff member with a written job description and maintain signed documentation acknowledging receipt in the staff file. Item #1825 – Emergency Preparedness and Response Plan (EPR) Review A new substitute staff member hired on 4/17/2026 had not reviewed the facility's Emergency Preparedness and Response Plan (EPR). To achieve compliance: Ensure all staff review the facility's Emergency Preparedness and Response Plan and maintain documentation of the review in the staff file. Item #1874 – Shaken Baby Syndrome Receipt A new substitute staff member hired on 4/17/2026 did not have documentation of receipt of Shaken Baby Syndrome training information on file for review. To achieve compliance: Ensure all required staff receive Shaken Baby Syndrome training/information and maintain signed documentation of receipt in the staff file. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 06/23/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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: Ownership Change We discussed you have signed lease agreement with Clay County, and you sent a copy to Monica Houck, Lead Consultant. You are waiting on the fire inspection. You have tentatively planned to closed July 6-10 for sanitation inspection (tentatively) and other ownership changes. We discussed that you have scheduled FA/CPR for A. Lee and A. Coffey for June 22, 2026. We discussed that Maltreatment training is due on or before 7/16/2026 for A. Lee and 8/25/2026 for A. Coffey. We discuss the LC Criminal Background qualifying letter will expire on 10/21/2026. Criminal Background Check every 5 years A criminal background check must be completed every five years. If an applicant changes employment while their qualification letter is valid and 180 days have not passed since employment in child care, the applicant must present a copy of the letter to the new employer to be kept on file. DCDEE recommends that applicants not let their criminal background check expire, so applicants should renew prior to the expiration date of the CBC letter. An individual may have their criminal background recheck completed as early as six months prior to the expiration date that is noted on the qualification letter. If an applicant has not been employed in child care within the last 180 days, a new application must be completed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/ If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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.
NC GS 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: Visit Date: 5/12/2026 Number Present: 22 Completed Date: 5/12/2026 Age: From 0 To 4 Total Minutes: 132 Time In: 09:33 AM Time Out: 11:45 AM Time In: Time Out: List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action final notice that was issued to the facility on 3/4/2026. A computerized generated report of today’s visit was completed, reviewed with you and signed by me, Bridget Owen Child Care Consultant and also signed by Lily Coffey, Administrator. A signed copy of the visit summary was left on site for you. Lily Coffey, Administrator, was in staff/child ratio in space #1 the classroom with two through four year old children and was able to assist with answering and asking questions. Ms. Coffey was released from the classroom ration when another teacher arrived at approximately 10:41 am. Upon arrival, the administrative action final notice, cover letter, and provisional license was posted at the entry where it could be viewed by parents and visitors. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (85%) as of 05/11/2026. The following was monitored during the visit, including, but not limited to: Supervision of children; Staff/child ratio; Discipline/Nurture Care of Children; Group size; Licensed capacity; Permit restriction; CPR/First Aid training; and ITS-SIDS training. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action was issued on 1/23/26. A final notice administrative action was issued on 3/4/2026. An intent to change ownership was received from Ms. Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The administrative action was reviewed with the administrator on 4/22/2026. The Corrective Action Plan (CAP) was monitored for compliance as follows: Item #1 – This item is not in compliance as violations were sited during today’s visit. Item #2- Operator has not completed and returned the statement of understanding. Failure to complete the CAP will result in a revocation of the license. On 3/27/26, the operator provided a written statement that Tiny Toes Learning Center Hayesville LLC will not be reinstated. Staff/child ratios was as follows: Space #1 – two (2) staff and eleven (11) children ages two through four years. Space # 2A- one (1) staff and five (5) children ages infant through one year. Space # 2B- one (1) staff and six (6) children ages one through two years. I observed the group of children ages two through four years engaged in outdoor play on Playground Space #1 with a variety of equipment, including riding toys, playhouses, and other mobile toys. The group of children ages one through two years engaged in outdoor play on Playground Space #2 with a variety of equipment and toys. The group of children ages zero through one year engaged in free play activities and moved freely throughout the room. Staff were observed providing nurturing, attentive, care to the children. Supervision was adequate. The following violations were documented during today’s visit: Violation Number Comment Rule 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. The last entry for two (2) infant sleep charts was dated 5/6/2026. Attendance was reviewed and both infants were in attendance on 5/7/26, 5/8/2026, and 5/11/26. .0606(g) 1048 All staff did not successfully complete certification in First Aid appropriate to the age of children in care. Verification of staff completion of First Aid training from an approved training organization was not in the staff file. Two teachers E.M. and K.M. were scheduled for First Aid on 4/16/2026 at Southwestern Development Commission and did not attend the training. J.W. First Aid expired on 4/28/26. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. Two teachers E.M. and K.M. were scheduled for CPR on 4/16/2026 at Southwestern Development Commission and did not attend the training. J.W. CPR expired on 4/28/26. .1102(d) Technical assistance was provided as follows: Sleep Charts Item #887 The last entry for two (2) infant sleep charts was dated 5/6/2026. Attendance was reviewed and both infants were in attendance on 5/7/26, 5/8/2026, and 5/11/26. To achieve compliance, teachers are expected to visually check and document on sleeping infants age 12 months or younger. I would suggest having a timer or alarm set for sleep chart reminders. First Aid Item # 1048 & CPR Item # 1049 Two teachers E.M. and K.M. were scheduled for First Aid and CPR on 4/16/2026 at Southwestern Development Commission did not attend the training. You stated the K.M has not been back to work since mid March 2026. One teacher J.W. First Aid and CPR expired on 4/28/26. You stated that E.M could not attend the First Aid and CPR training on 4/16/2026 due to having to stay home with her sick child. To achieve compliance, E. M. and J.W. must complete First Aid and CPR immediately. Achieving Compliance: Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 5/27/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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: We discussed you have a copy of the lease to review, and you have a meeting next Tuesday or Wednesday with the Clay County for both parties to sign the lease. We discussed that you will have EM and JW take the next available First Aid and CPR class that you believe is on May 16, 2026. AL First Aid and CPR will expire on 5/21/2026. We discuss the LC Criminal Background qualifying letter will expire on 10/21/2026. Criminal Background Check every 5 years: A criminal background check must be completed every five years. If an applicant changes employment while their qualification letter is valid and 180 days have not passed since employment in child care, the applicant must present a copy of the letter to the new employer to be kept on file. DCDEE recommends that applicants not let their criminal background check expire, so applicants should renew prior to the expiration date of the CBC letter. An individual may have their criminal background recheck completed as early as six months prior to the expiration date that is noted on the qualification letter. If an applicant has not been employed in child care within the last 180 days, a new application must be completed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/ If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424, 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 .0601 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: 0226-174L Visit Date: 3/2/2026 Number Present: 26 Completed Date: 3/2/2026 Age: From 0 To 4 Total Minutes: 155 Time In: 10:10 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Bridget Owen, Child Care Consultant and also signed by Lily Coffey, Administrator during the visit. Monica Houck, Lead License Consultant, accompanied me. A signed copy of the visit summary was left on-site for you. Lily Coffey, Administrator, was in staff/child ratio in space #2B, the classroom with one and two year old children, and was able to assist with answering and asking questions. The facility operates with a four-star license issued on 12/31/2025 The four-star license was posted. The Special Services/Restrictions includes Daytime care; meets enhanced ratios, meets enhanced space. This program is not approved for transportation. A prior notice administrative action for the administratively dissolved Limited Liability Company was received by the legal operator on 02/05/2026. The deadline to appeal was 02/20/2026 and the final notice will be mailed, which will result in a change of license to a Provisional License. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (83%) as of 02/27/2026. The complaint was received by the Division of Child Development and Early Education on 02/19/2026 and sent to Bridget Owen on 02/19/2026. Allegations within the report include the following: * There are concerns regarding safe environment, Staff/Child Interactions, and nurturing in an appropriate manner. In addition to addressing the allegations, staff/child ratio, group size, supervision, use of licensed space, space capacity, permit restrictions, license posted, health, nurture, care, and safe environment were monitored. A complete walkthrough of the facility was conducted. During today’s walkthrough, staff were observed engaged in direct caregiving activities, the group in space 2b were engaged in free play activities. A total of six (6) children between one (1) and two (2) years of age. The group in space 2a were engaged in free play activities. A total of five (5) children with an infant and one year old children. The group in space 1 were engaged in outdoor play with a variety of equipment including riding toys, playhouses, and other mobile toys. Allegations regarding safe environment are addressed as follows: There are concerns the facility did not provide a safe environment for toddlers. Safe Environment 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) All child care centers shall provide a safe indoor and outdoor environment for the children in care. During the walkthrough, staff in the toddler room were observed interacting with children in a positive and appropriate manner. The classroom environment appeared safe, organized, and conducive to learning. Allegations regarding staff/child interactions are addressed as follows: There are concerns the staff/child interactions with toddlers were not positive. Staff/Child interaction 10A NCAC 09 .1802 STAFF/CHILD INTERACTIONS Staff shall interact with children in positive ways by helping them feel welcome and comfortable, treating them with respect, listening to what they say, responding to them with acceptance and appreciation, and participating in activities with the children. For example, staff shall: (1) make eye contact when speaking to a child; (2) engage children in conversation to share experiences, ideas, and opinions; (3) help children develop problem-solving skills; and (4) facilitate learning by providing positive reinforcement, encouraging efforts, and recognizing accomplishments. During the walkthrough staff were observed in the toddler room interacting with children positively. Additionally, staff were observed singing with children. Allegations regarding nurturing in an appropriate manner are addressed as follows: There are concerns the facility did not provide nurturing in an appropriate manner. § 110 91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school age children of the operator of a child care facility but do apply to the preschool age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part time, drop in, seasonal, after school or other than a full time basis (10) Each operator or staff member shall attend to any child in a nurturing and appropriate manner, and in keeping with the child's developmental needs. Each child care facility shall have a written policy on discipline, describing the methods and practices used to discipline children enrolled in that facility. This written policy shall be discussed with, and a copy given to, each child's parent prior to the first time the child attends the facility. Subsequently, any change in discipline methods or practices shall be communicated in writing to the parents prior to the effective date of the change. The use of corporal punishment as a form of discipline is prohibited in child care facilities and may not be used by any operator or staff member of any child care facility, except that corporal punishment may be used in religious sponsored child care facilities as defined in G.S. 110 106, only if (i) the religious sponsored child care facility files with the Department a notice stating that corporal punishment is part of the religious training of its program, and (ii) the religious sponsored child care facility clearly states in its written policy of discipline that corporal punishment is part of the religious training of its program. The written policy on discipline of nonreligious sponsored child care facilities shall clearly state the prohibition on corporal punishment Staff were observed providing nurturing, attentive, and developmentally appropriate care to the children. Staff members were interviewed regarding the allegation. All staff present during today’s visit stated they were not aware of any incidents involving staff yelling at toddlers. Staff provided examples of situations in which a raised voice may be used appropriately, such as during an emergency. For example, if two (2) children were fighting over a toy and one child was about to bite another, a teacher may raise their voice briefly to prevent injury and gain the child’s immediate attention. Additionally, one (1) staff member who was not present during today’s visit was interviewed by phone and stated they were not aware of any staff members yelling at toddlers. The staff member explained that if a toddler is engaging in inappropriate behavior, they would ask the child to stop and provide redirection as needed. The Behavior Management Policy used at the facility and signed acknowledgements by parents/families states that: No child shall be subjected to any form of corporal punishment. Praise and positive reinforcement are effective methods of the behavior management of children. When children receive positive, non-violent, and understanding interactions from adults and others, they develop good self-concepts, problem solving abilities, and self-discipline. Based on this belief of how children learn and develop values, this facility will practice the following age and developmentally appropriate discipline and behavior management policy They: DO NOT handle children roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. DO NOT place children in a locked room, closet, or box or leave children alone in a room separated from staff. DO NOT delegate discipline to another child. DO NOT withhold food as punishment or give food as a means of reward. DO NOT discipline for toileting accidents. DO NOT discipline for not sleeping during rest period. DO NOT discipline children by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms, floors, or emptying diaper pails. 8. DO NOT withhold or require physical activity, such as running laps and doing push-ups, as punishment. DO NOT yell at, shame, humiliate, frighten, threaten, or bully children. DO NOT restrain children as a form of discipline unless the child’s safety or the safety of others is at risk. During our observation in the toddler classroom, staff were observed interacting with children in a calm appropriate manner. No instances of yelling were observed during the visit. Based on the interview and observation conducted during the visit the allegations regarding safe environment staff/child interactions, and nurturing in an appropriate manner were unsubstantiated. Staff/child ratios during the visit were as follows: Space #1 – two (2) staff and fifteen (15) children ages two through four years. Space #2A – one (1) staff and five (5) infant through one year old children. Space #2B – one (1) staff and six (6) children ages one and two years. The CAP was monitored for compliance as follows: Item #1 – There were two (2) violations of child care requirements during the visit today. This item is not in compliance. Item #2- This item has been completed and is in compliance. Item #3- This item has been completed and is in compliance. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. Ms. Coffey emailed the plans for review on 2/26/26. The plans have been reviewed and revisions to the plan by Ms. Coffey are in process. The following violations were observed during the visit today. Violation Number Comment Rule 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. An infant in attendance on 2/13/26, from approximately 7:30am until approximately 5:00pm, did not have documentation that the teacher visually checked on the sleeping infant. .0606(g) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19). The prior notice administrative action and cover letter, dated 1/23/26, were not posted. 10A NCAC 09 .2201(i)(1-4) Technical Assistance Item #1948 You stated the legal operator, Kaitlyn Frady, had not provided you with the administrative action and cover letter to post. We provided you with a copy of the administrative action and cover letter during the visit. This was corrected during the visit. A final notice will be mailed soon. Plan to post the administrative action, cover letter, and provisional license once received. Once the provisional license is posted, the four-star license will need to be taken down. The four-star license will be collected at a future visit. Item #887 To achieve compliance, you stated you would continue what you started last week, which was to review the safe sleep charts each day. You are working on your final plan for safe sleep checks. Achieving Compliance: The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 03/16/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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 a training opportunity for staff working in the toddler classroom through Southwestern Child Development Commission titled “Stay With Me: Continuity of Care for Infants and Toddlers.” The administrator was informed that staff may register for this training using the link provided below: https://reg.learningstream.com/reg/event_page.aspx?ek=0042-0007-cdd687d70bdf4c00b15fa6d39d1a04f6. Discussion included the importance of maintaining a calm and developmentally appropriate tone of voice when addressing toddlers. It was reviewed that raising one’s voice, even when redirecting behavior, may cause distress and is not considered a positive guidance technique. Examples of appropriate guidance strategies were discussed, including: • Getting down to the child’s eye level before giving directions • Using a calm, clear voice when providing redirection • Offering simple, age-appropriate instructions (e.g., “Feet on the floor” instead of repeated directives) • Using positive phrasing (e.g., “Please sit on your bottom” rather than “Stop it”) • Redirecting children to another activity when behaviors escalate • Modeling expected behavior • Using proximity and gentle reminders rather than raised voice volume The importance of consistent classroom management strategies and staff self-awareness regarding tone and volume was emphasized. The administrator was encouraged to review positive guidance policies with all staff and provide additional training if needed. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424 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 .1802 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: 0226-174L Visit Date: 3/2/2026 Number Present: 26 Completed Date: 3/2/2026 Age: From 0 To 4 Total Minutes: 155 Time In: 10:10 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Bridget Owen, Child Care Consultant and also signed by Lily Coffey, Administrator during the visit. Monica Houck, Lead License Consultant, accompanied me. A signed copy of the visit summary was left on-site for you. Lily Coffey, Administrator, was in staff/child ratio in space #2B, the classroom with one and two year old children, and was able to assist with answering and asking questions. The facility operates with a four-star license issued on 12/31/2025 The four-star license was posted. The Special Services/Restrictions includes Daytime care; meets enhanced ratios, meets enhanced space. This program is not approved for transportation. A prior notice administrative action for the administratively dissolved Limited Liability Company was received by the legal operator on 02/05/2026. The deadline to appeal was 02/20/2026 and the final notice will be mailed, which will result in a change of license to a Provisional License. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (83%) as of 02/27/2026. The complaint was received by the Division of Child Development and Early Education on 02/19/2026 and sent to Bridget Owen on 02/19/2026. Allegations within the report include the following: * There are concerns regarding safe environment, Staff/Child Interactions, and nurturing in an appropriate manner. In addition to addressing the allegations, staff/child ratio, group size, supervision, use of licensed space, space capacity, permit restrictions, license posted, health, nurture, care, and safe environment were monitored. A complete walkthrough of the facility was conducted. During today’s walkthrough, staff were observed engaged in direct caregiving activities, the group in space 2b were engaged in free play activities. A total of six (6) children between one (1) and two (2) years of age. The group in space 2a were engaged in free play activities. A total of five (5) children with an infant and one year old children. The group in space 1 were engaged in outdoor play with a variety of equipment including riding toys, playhouses, and other mobile toys. Allegations regarding safe environment are addressed as follows: There are concerns the facility did not provide a safe environment for toddlers. Safe Environment 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) All child care centers shall provide a safe indoor and outdoor environment for the children in care. During the walkthrough, staff in the toddler room were observed interacting with children in a positive and appropriate manner. The classroom environment appeared safe, organized, and conducive to learning. Allegations regarding staff/child interactions are addressed as follows: There are concerns the staff/child interactions with toddlers were not positive. Staff/Child interaction 10A NCAC 09 .1802 STAFF/CHILD INTERACTIONS Staff shall interact with children in positive ways by helping them feel welcome and comfortable, treating them with respect, listening to what they say, responding to them with acceptance and appreciation, and participating in activities with the children. For example, staff shall: (1) make eye contact when speaking to a child; (2) engage children in conversation to share experiences, ideas, and opinions; (3) help children develop problem-solving skills; and (4) facilitate learning by providing positive reinforcement, encouraging efforts, and recognizing accomplishments. During the walkthrough staff were observed in the toddler room interacting with children positively. Additionally, staff were observed singing with children. Allegations regarding nurturing in an appropriate manner are addressed as follows: There are concerns the facility did not provide nurturing in an appropriate manner. § 110 91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school age children of the operator of a child care facility but do apply to the preschool age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part time, drop in, seasonal, after school or other than a full time basis (10) Each operator or staff member shall attend to any child in a nurturing and appropriate manner, and in keeping with the child's developmental needs. Each child care facility shall have a written policy on discipline, describing the methods and practices used to discipline children enrolled in that facility. This written policy shall be discussed with, and a copy given to, each child's parent prior to the first time the child attends the facility. Subsequently, any change in discipline methods or practices shall be communicated in writing to the parents prior to the effective date of the change. The use of corporal punishment as a form of discipline is prohibited in child care facilities and may not be used by any operator or staff member of any child care facility, except that corporal punishment may be used in religious sponsored child care facilities as defined in G.S. 110 106, only if (i) the religious sponsored child care facility files with the Department a notice stating that corporal punishment is part of the religious training of its program, and (ii) the religious sponsored child care facility clearly states in its written policy of discipline that corporal punishment is part of the religious training of its program. The written policy on discipline of nonreligious sponsored child care facilities shall clearly state the prohibition on corporal punishment Staff were observed providing nurturing, attentive, and developmentally appropriate care to the children. Staff members were interviewed regarding the allegation. All staff present during today’s visit stated they were not aware of any incidents involving staff yelling at toddlers. Staff provided examples of situations in which a raised voice may be used appropriately, such as during an emergency. For example, if two (2) children were fighting over a toy and one child was about to bite another, a teacher may raise their voice briefly to prevent injury and gain the child’s immediate attention. Additionally, one (1) staff member who was not present during today’s visit was interviewed by phone and stated they were not aware of any staff members yelling at toddlers. The staff member explained that if a toddler is engaging in inappropriate behavior, they would ask the child to stop and provide redirection as needed. The Behavior Management Policy used at the facility and signed acknowledgements by parents/families states that: No child shall be subjected to any form of corporal punishment. Praise and positive reinforcement are effective methods of the behavior management of children. When children receive positive, non-violent, and understanding interactions from adults and others, they develop good self-concepts, problem solving abilities, and self-discipline. Based on this belief of how children learn and develop values, this facility will practice the following age and developmentally appropriate discipline and behavior management policy They: DO NOT handle children roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. DO NOT place children in a locked room, closet, or box or leave children alone in a room separated from staff. DO NOT delegate discipline to another child. DO NOT withhold food as punishment or give food as a means of reward. DO NOT discipline for toileting accidents. DO NOT discipline for not sleeping during rest period. DO NOT discipline children by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms, floors, or emptying diaper pails. 8. DO NOT withhold or require physical activity, such as running laps and doing push-ups, as punishment. DO NOT yell at, shame, humiliate, frighten, threaten, or bully children. DO NOT restrain children as a form of discipline unless the child’s safety or the safety of others is at risk. During our observation in the toddler classroom, staff were observed interacting with children in a calm appropriate manner. No instances of yelling were observed during the visit. Based on the interview and observation conducted during the visit the allegations regarding safe environment staff/child interactions, and nurturing in an appropriate manner were unsubstantiated. Staff/child ratios during the visit were as follows: Space #1 – two (2) staff and fifteen (15) children ages two through four years. Space #2A – one (1) staff and five (5) infant through one year old children. Space #2B – one (1) staff and six (6) children ages one and two years. The CAP was monitored for compliance as follows: Item #1 – There were two (2) violations of child care requirements during the visit today. This item is not in compliance. Item #2- This item has been completed and is in compliance. Item #3- This item has been completed and is in compliance. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. Ms. Coffey emailed the plans for review on 2/26/26. The plans have been reviewed and revisions to the plan by Ms. Coffey are in process. The following violations were observed during the visit today. Violation Number Comment Rule 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. An infant in attendance on 2/13/26, from approximately 7:30am until approximately 5:00pm, did not have documentation that the teacher visually checked on the sleeping infant. .0606(g) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19). The prior notice administrative action and cover letter, dated 1/23/26, were not posted. 10A NCAC 09 .2201(i)(1-4) Technical Assistance Item #1948 You stated the legal operator, Kaitlyn Frady, had not provided you with the administrative action and cover letter to post. We provided you with a copy of the administrative action and cover letter during the visit. This was corrected during the visit. A final notice will be mailed soon. Plan to post the administrative action, cover letter, and provisional license once received. Once the provisional license is posted, the four-star license will need to be taken down. The four-star license will be collected at a future visit. Item #887 To achieve compliance, you stated you would continue what you started last week, which was to review the safe sleep charts each day. You are working on your final plan for safe sleep checks. Achieving Compliance: The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 03/16/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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 a training opportunity for staff working in the toddler classroom through Southwestern Child Development Commission titled “Stay With Me: Continuity of Care for Infants and Toddlers.” The administrator was informed that staff may register for this training using the link provided below: https://reg.learningstream.com/reg/event_page.aspx?ek=0042-0007-cdd687d70bdf4c00b15fa6d39d1a04f6. Discussion included the importance of maintaining a calm and developmentally appropriate tone of voice when addressing toddlers. It was reviewed that raising one’s voice, even when redirecting behavior, may cause distress and is not considered a positive guidance technique. Examples of appropriate guidance strategies were discussed, including: • Getting down to the child’s eye level before giving directions • Using a calm, clear voice when providing redirection • Offering simple, age-appropriate instructions (e.g., “Feet on the floor” instead of repeated directives) • Using positive phrasing (e.g., “Please sit on your bottom” rather than “Stop it”) • Redirecting children to another activity when behaviors escalate • Modeling expected behavior • Using proximity and gentle reminders rather than raised voice volume The importance of consistent classroom management strategies and staff self-awareness regarding tone and volume was emphasized. The administrator was encouraged to review positive guidance policies with all staff and provide additional training if needed. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424 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 .2201 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: 0226-174L Visit Date: 3/2/2026 Number Present: 26 Completed Date: 3/2/2026 Age: From 0 To 4 Total Minutes: 155 Time In: 10:10 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Bridget Owen, Child Care Consultant and also signed by Lily Coffey, Administrator during the visit. Monica Houck, Lead License Consultant, accompanied me. A signed copy of the visit summary was left on-site for you. Lily Coffey, Administrator, was in staff/child ratio in space #2B, the classroom with one and two year old children, and was able to assist with answering and asking questions. The facility operates with a four-star license issued on 12/31/2025 The four-star license was posted. The Special Services/Restrictions includes Daytime care; meets enhanced ratios, meets enhanced space. This program is not approved for transportation. A prior notice administrative action for the administratively dissolved Limited Liability Company was received by the legal operator on 02/05/2026. The deadline to appeal was 02/20/2026 and the final notice will be mailed, which will result in a change of license to a Provisional License. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (83%) as of 02/27/2026. The complaint was received by the Division of Child Development and Early Education on 02/19/2026 and sent to Bridget Owen on 02/19/2026. Allegations within the report include the following: * There are concerns regarding safe environment, Staff/Child Interactions, and nurturing in an appropriate manner. In addition to addressing the allegations, staff/child ratio, group size, supervision, use of licensed space, space capacity, permit restrictions, license posted, health, nurture, care, and safe environment were monitored. A complete walkthrough of the facility was conducted. During today’s walkthrough, staff were observed engaged in direct caregiving activities, the group in space 2b were engaged in free play activities. A total of six (6) children between one (1) and two (2) years of age. The group in space 2a were engaged in free play activities. A total of five (5) children with an infant and one year old children. The group in space 1 were engaged in outdoor play with a variety of equipment including riding toys, playhouses, and other mobile toys. Allegations regarding safe environment are addressed as follows: There are concerns the facility did not provide a safe environment for toddlers. Safe Environment 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) All child care centers shall provide a safe indoor and outdoor environment for the children in care. During the walkthrough, staff in the toddler room were observed interacting with children in a positive and appropriate manner. The classroom environment appeared safe, organized, and conducive to learning. Allegations regarding staff/child interactions are addressed as follows: There are concerns the staff/child interactions with toddlers were not positive. Staff/Child interaction 10A NCAC 09 .1802 STAFF/CHILD INTERACTIONS Staff shall interact with children in positive ways by helping them feel welcome and comfortable, treating them with respect, listening to what they say, responding to them with acceptance and appreciation, and participating in activities with the children. For example, staff shall: (1) make eye contact when speaking to a child; (2) engage children in conversation to share experiences, ideas, and opinions; (3) help children develop problem-solving skills; and (4) facilitate learning by providing positive reinforcement, encouraging efforts, and recognizing accomplishments. During the walkthrough staff were observed in the toddler room interacting with children positively. Additionally, staff were observed singing with children. Allegations regarding nurturing in an appropriate manner are addressed as follows: There are concerns the facility did not provide nurturing in an appropriate manner. § 110 91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school age children of the operator of a child care facility but do apply to the preschool age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part time, drop in, seasonal, after school or other than a full time basis (10) Each operator or staff member shall attend to any child in a nurturing and appropriate manner, and in keeping with the child's developmental needs. Each child care facility shall have a written policy on discipline, describing the methods and practices used to discipline children enrolled in that facility. This written policy shall be discussed with, and a copy given to, each child's parent prior to the first time the child attends the facility. Subsequently, any change in discipline methods or practices shall be communicated in writing to the parents prior to the effective date of the change. The use of corporal punishment as a form of discipline is prohibited in child care facilities and may not be used by any operator or staff member of any child care facility, except that corporal punishment may be used in religious sponsored child care facilities as defined in G.S. 110 106, only if (i) the religious sponsored child care facility files with the Department a notice stating that corporal punishment is part of the religious training of its program, and (ii) the religious sponsored child care facility clearly states in its written policy of discipline that corporal punishment is part of the religious training of its program. The written policy on discipline of nonreligious sponsored child care facilities shall clearly state the prohibition on corporal punishment Staff were observed providing nurturing, attentive, and developmentally appropriate care to the children. Staff members were interviewed regarding the allegation. All staff present during today’s visit stated they were not aware of any incidents involving staff yelling at toddlers. Staff provided examples of situations in which a raised voice may be used appropriately, such as during an emergency. For example, if two (2) children were fighting over a toy and one child was about to bite another, a teacher may raise their voice briefly to prevent injury and gain the child’s immediate attention. Additionally, one (1) staff member who was not present during today’s visit was interviewed by phone and stated they were not aware of any staff members yelling at toddlers. The staff member explained that if a toddler is engaging in inappropriate behavior, they would ask the child to stop and provide redirection as needed. The Behavior Management Policy used at the facility and signed acknowledgements by parents/families states that: No child shall be subjected to any form of corporal punishment. Praise and positive reinforcement are effective methods of the behavior management of children. When children receive positive, non-violent, and understanding interactions from adults and others, they develop good self-concepts, problem solving abilities, and self-discipline. Based on this belief of how children learn and develop values, this facility will practice the following age and developmentally appropriate discipline and behavior management policy They: DO NOT handle children roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. DO NOT place children in a locked room, closet, or box or leave children alone in a room separated from staff. DO NOT delegate discipline to another child. DO NOT withhold food as punishment or give food as a means of reward. DO NOT discipline for toileting accidents. DO NOT discipline for not sleeping during rest period. DO NOT discipline children by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms, floors, or emptying diaper pails. 8. DO NOT withhold or require physical activity, such as running laps and doing push-ups, as punishment. DO NOT yell at, shame, humiliate, frighten, threaten, or bully children. DO NOT restrain children as a form of discipline unless the child’s safety or the safety of others is at risk. During our observation in the toddler classroom, staff were observed interacting with children in a calm appropriate manner. No instances of yelling were observed during the visit. Based on the interview and observation conducted during the visit the allegations regarding safe environment staff/child interactions, and nurturing in an appropriate manner were unsubstantiated. Staff/child ratios during the visit were as follows: Space #1 – two (2) staff and fifteen (15) children ages two through four years. Space #2A – one (1) staff and five (5) infant through one year old children. Space #2B – one (1) staff and six (6) children ages one and two years. The CAP was monitored for compliance as follows: Item #1 – There were two (2) violations of child care requirements during the visit today. This item is not in compliance. Item #2- This item has been completed and is in compliance. Item #3- This item has been completed and is in compliance. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. Ms. Coffey emailed the plans for review on 2/26/26. The plans have been reviewed and revisions to the plan by Ms. Coffey are in process. The following violations were observed during the visit today. Violation Number Comment Rule 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. An infant in attendance on 2/13/26, from approximately 7:30am until approximately 5:00pm, did not have documentation that the teacher visually checked on the sleeping infant. .0606(g) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19). The prior notice administrative action and cover letter, dated 1/23/26, were not posted. 10A NCAC 09 .2201(i)(1-4) Technical Assistance Item #1948 You stated the legal operator, Kaitlyn Frady, had not provided you with the administrative action and cover letter to post. We provided you with a copy of the administrative action and cover letter during the visit. This was corrected during the visit. A final notice will be mailed soon. Plan to post the administrative action, cover letter, and provisional license once received. Once the provisional license is posted, the four-star license will need to be taken down. The four-star license will be collected at a future visit. Item #887 To achieve compliance, you stated you would continue what you started last week, which was to review the safe sleep charts each day. You are working on your final plan for safe sleep checks. Achieving Compliance: The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 03/16/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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 a training opportunity for staff working in the toddler classroom through Southwestern Child Development Commission titled “Stay With Me: Continuity of Care for Infants and Toddlers.” The administrator was informed that staff may register for this training using the link provided below: https://reg.learningstream.com/reg/event_page.aspx?ek=0042-0007-cdd687d70bdf4c00b15fa6d39d1a04f6. Discussion included the importance of maintaining a calm and developmentally appropriate tone of voice when addressing toddlers. It was reviewed that raising one’s voice, even when redirecting behavior, may cause distress and is not considered a positive guidance technique. Examples of appropriate guidance strategies were discussed, including: • Getting down to the child’s eye level before giving directions • Using a calm, clear voice when providing redirection • Offering simple, age-appropriate instructions (e.g., “Feet on the floor” instead of repeated directives) • Using positive phrasing (e.g., “Please sit on your bottom” rather than “Stop it”) • Redirecting children to another activity when behaviors escalate • Modeling expected behavior • Using proximity and gentle reminders rather than raised voice volume The importance of consistent classroom management strategies and staff self-awareness regarding tone and volume was emphasized. The administrator was encouraged to review positive guidance policies with all staff and provide additional training if needed. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424 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. 110 106 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: 0226-174L Visit Date: 3/2/2026 Number Present: 26 Completed Date: 3/2/2026 Age: From 0 To 4 Total Minutes: 155 Time In: 10:10 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Bridget Owen, Child Care Consultant and also signed by Lily Coffey, Administrator during the visit. Monica Houck, Lead License Consultant, accompanied me. A signed copy of the visit summary was left on-site for you. Lily Coffey, Administrator, was in staff/child ratio in space #2B, the classroom with one and two year old children, and was able to assist with answering and asking questions. The facility operates with a four-star license issued on 12/31/2025 The four-star license was posted. The Special Services/Restrictions includes Daytime care; meets enhanced ratios, meets enhanced space. This program is not approved for transportation. A prior notice administrative action for the administratively dissolved Limited Liability Company was received by the legal operator on 02/05/2026. The deadline to appeal was 02/20/2026 and the final notice will be mailed, which will result in a change of license to a Provisional License. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (83%) as of 02/27/2026. The complaint was received by the Division of Child Development and Early Education on 02/19/2026 and sent to Bridget Owen on 02/19/2026. Allegations within the report include the following: * There are concerns regarding safe environment, Staff/Child Interactions, and nurturing in an appropriate manner. In addition to addressing the allegations, staff/child ratio, group size, supervision, use of licensed space, space capacity, permit restrictions, license posted, health, nurture, care, and safe environment were monitored. A complete walkthrough of the facility was conducted. During today’s walkthrough, staff were observed engaged in direct caregiving activities, the group in space 2b were engaged in free play activities. A total of six (6) children between one (1) and two (2) years of age. The group in space 2a were engaged in free play activities. A total of five (5) children with an infant and one year old children. The group in space 1 were engaged in outdoor play with a variety of equipment including riding toys, playhouses, and other mobile toys. Allegations regarding safe environment are addressed as follows: There are concerns the facility did not provide a safe environment for toddlers. Safe Environment 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) All child care centers shall provide a safe indoor and outdoor environment for the children in care. During the walkthrough, staff in the toddler room were observed interacting with children in a positive and appropriate manner. The classroom environment appeared safe, organized, and conducive to learning. Allegations regarding staff/child interactions are addressed as follows: There are concerns the staff/child interactions with toddlers were not positive. Staff/Child interaction 10A NCAC 09 .1802 STAFF/CHILD INTERACTIONS Staff shall interact with children in positive ways by helping them feel welcome and comfortable, treating them with respect, listening to what they say, responding to them with acceptance and appreciation, and participating in activities with the children. For example, staff shall: (1) make eye contact when speaking to a child; (2) engage children in conversation to share experiences, ideas, and opinions; (3) help children develop problem-solving skills; and (4) facilitate learning by providing positive reinforcement, encouraging efforts, and recognizing accomplishments. During the walkthrough staff were observed in the toddler room interacting with children positively. Additionally, staff were observed singing with children. Allegations regarding nurturing in an appropriate manner are addressed as follows: There are concerns the facility did not provide nurturing in an appropriate manner. § 110 91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school age children of the operator of a child care facility but do apply to the preschool age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part time, drop in, seasonal, after school or other than a full time basis (10) Each operator or staff member shall attend to any child in a nurturing and appropriate manner, and in keeping with the child's developmental needs. Each child care facility shall have a written policy on discipline, describing the methods and practices used to discipline children enrolled in that facility. This written policy shall be discussed with, and a copy given to, each child's parent prior to the first time the child attends the facility. Subsequently, any change in discipline methods or practices shall be communicated in writing to the parents prior to the effective date of the change. The use of corporal punishment as a form of discipline is prohibited in child care facilities and may not be used by any operator or staff member of any child care facility, except that corporal punishment may be used in religious sponsored child care facilities as defined in G.S. 110 106, only if (i) the religious sponsored child care facility files with the Department a notice stating that corporal punishment is part of the religious training of its program, and (ii) the religious sponsored child care facility clearly states in its written policy of discipline that corporal punishment is part of the religious training of its program. The written policy on discipline of nonreligious sponsored child care facilities shall clearly state the prohibition on corporal punishment Staff were observed providing nurturing, attentive, and developmentally appropriate care to the children. Staff members were interviewed regarding the allegation. All staff present during today’s visit stated they were not aware of any incidents involving staff yelling at toddlers. Staff provided examples of situations in which a raised voice may be used appropriately, such as during an emergency. For example, if two (2) children were fighting over a toy and one child was about to bite another, a teacher may raise their voice briefly to prevent injury and gain the child’s immediate attention. Additionally, one (1) staff member who was not present during today’s visit was interviewed by phone and stated they were not aware of any staff members yelling at toddlers. The staff member explained that if a toddler is engaging in inappropriate behavior, they would ask the child to stop and provide redirection as needed. The Behavior Management Policy used at the facility and signed acknowledgements by parents/families states that: No child shall be subjected to any form of corporal punishment. Praise and positive reinforcement are effective methods of the behavior management of children. When children receive positive, non-violent, and understanding interactions from adults and others, they develop good self-concepts, problem solving abilities, and self-discipline. Based on this belief of how children learn and develop values, this facility will practice the following age and developmentally appropriate discipline and behavior management policy They: DO NOT handle children roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. DO NOT place children in a locked room, closet, or box or leave children alone in a room separated from staff. DO NOT delegate discipline to another child. DO NOT withhold food as punishment or give food as a means of reward. DO NOT discipline for toileting accidents. DO NOT discipline for not sleeping during rest period. DO NOT discipline children by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms, floors, or emptying diaper pails. 8. DO NOT withhold or require physical activity, such as running laps and doing push-ups, as punishment. DO NOT yell at, shame, humiliate, frighten, threaten, or bully children. DO NOT restrain children as a form of discipline unless the child’s safety or the safety of others is at risk. During our observation in the toddler classroom, staff were observed interacting with children in a calm appropriate manner. No instances of yelling were observed during the visit. Based on the interview and observation conducted during the visit the allegations regarding safe environment staff/child interactions, and nurturing in an appropriate manner were unsubstantiated. Staff/child ratios during the visit were as follows: Space #1 – two (2) staff and fifteen (15) children ages two through four years. Space #2A – one (1) staff and five (5) infant through one year old children. Space #2B – one (1) staff and six (6) children ages one and two years. The CAP was monitored for compliance as follows: Item #1 – There were two (2) violations of child care requirements during the visit today. This item is not in compliance. Item #2- This item has been completed and is in compliance. Item #3- This item has been completed and is in compliance. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. Ms. Coffey emailed the plans for review on 2/26/26. The plans have been reviewed and revisions to the plan by Ms. Coffey are in process. The following violations were observed during the visit today. Violation Number Comment Rule 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. An infant in attendance on 2/13/26, from approximately 7:30am until approximately 5:00pm, did not have documentation that the teacher visually checked on the sleeping infant. .0606(g) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19). The prior notice administrative action and cover letter, dated 1/23/26, were not posted. 10A NCAC 09 .2201(i)(1-4) Technical Assistance Item #1948 You stated the legal operator, Kaitlyn Frady, had not provided you with the administrative action and cover letter to post. We provided you with a copy of the administrative action and cover letter during the visit. This was corrected during the visit. A final notice will be mailed soon. Plan to post the administrative action, cover letter, and provisional license once received. Once the provisional license is posted, the four-star license will need to be taken down. The four-star license will be collected at a future visit. Item #887 To achieve compliance, you stated you would continue what you started last week, which was to review the safe sleep charts each day. You are working on your final plan for safe sleep checks. Achieving Compliance: The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 03/16/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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 a training opportunity for staff working in the toddler classroom through Southwestern Child Development Commission titled “Stay With Me: Continuity of Care for Infants and Toddlers.” The administrator was informed that staff may register for this training using the link provided below: https://reg.learningstream.com/reg/event_page.aspx?ek=0042-0007-cdd687d70bdf4c00b15fa6d39d1a04f6. Discussion included the importance of maintaining a calm and developmentally appropriate tone of voice when addressing toddlers. It was reviewed that raising one’s voice, even when redirecting behavior, may cause distress and is not considered a positive guidance technique. Examples of appropriate guidance strategies were discussed, including: • Getting down to the child’s eye level before giving directions • Using a calm, clear voice when providing redirection • Offering simple, age-appropriate instructions (e.g., “Feet on the floor” instead of repeated directives) • Using positive phrasing (e.g., “Please sit on your bottom” rather than “Stop it”) • Redirecting children to another activity when behaviors escalate • Modeling expected behavior • Using proximity and gentle reminders rather than raised voice volume The importance of consistent classroom management strategies and staff self-awareness regarding tone and volume was emphasized. The administrator was encouraged to review positive guidance policies with all staff and provide additional training if needed. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424 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: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: BRIDGET OWEN Operation Type: Center Case Number: 0226-174L Visit Date: 3/2/2026 Number Present: 26 Completed Date: 3/2/2026 Age: From 0 To 4 Total Minutes: 155 Time In: 10:10 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s visit is to investigate allegations of child care requirements. A computerized generated report of today’s visit was completed, reviewed with you, and signed by me, Bridget Owen, Child Care Consultant and also signed by Lily Coffey, Administrator during the visit. Monica Houck, Lead License Consultant, accompanied me. A signed copy of the visit summary was left on-site for you. Lily Coffey, Administrator, was in staff/child ratio in space #2B, the classroom with one and two year old children, and was able to assist with answering and asking questions. The facility operates with a four-star license issued on 12/31/2025 The four-star license was posted. The Special Services/Restrictions includes Daytime care; meets enhanced ratios, meets enhanced space. This program is not approved for transportation. A prior notice administrative action for the administratively dissolved Limited Liability Company was received by the legal operator on 02/05/2026. The deadline to appeal was 02/20/2026 and the final notice will be mailed, which will result in a change of license to a Provisional License. The center’s compliance history was reviewed with the operator. The program’s compliance history is eighty-three percent (83%) as of 02/27/2026. The complaint was received by the Division of Child Development and Early Education on 02/19/2026 and sent to Bridget Owen on 02/19/2026. Allegations within the report include the following: * There are concerns regarding safe environment, Staff/Child Interactions, and nurturing in an appropriate manner. In addition to addressing the allegations, staff/child ratio, group size, supervision, use of licensed space, space capacity, permit restrictions, license posted, health, nurture, care, and safe environment were monitored. A complete walkthrough of the facility was conducted. During today’s walkthrough, staff were observed engaged in direct caregiving activities, the group in space 2b were engaged in free play activities. A total of six (6) children between one (1) and two (2) years of age. The group in space 2a were engaged in free play activities. A total of five (5) children with an infant and one year old children. The group in space 1 were engaged in outdoor play with a variety of equipment including riding toys, playhouses, and other mobile toys. Allegations regarding safe environment are addressed as follows: There are concerns the facility did not provide a safe environment for toddlers. Safe Environment 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) All child care centers shall provide a safe indoor and outdoor environment for the children in care. During the walkthrough, staff in the toddler room were observed interacting with children in a positive and appropriate manner. The classroom environment appeared safe, organized, and conducive to learning. Allegations regarding staff/child interactions are addressed as follows: There are concerns the staff/child interactions with toddlers were not positive. Staff/Child interaction 10A NCAC 09 .1802 STAFF/CHILD INTERACTIONS Staff shall interact with children in positive ways by helping them feel welcome and comfortable, treating them with respect, listening to what they say, responding to them with acceptance and appreciation, and participating in activities with the children. For example, staff shall: (1) make eye contact when speaking to a child; (2) engage children in conversation to share experiences, ideas, and opinions; (3) help children develop problem-solving skills; and (4) facilitate learning by providing positive reinforcement, encouraging efforts, and recognizing accomplishments. During the walkthrough staff were observed in the toddler room interacting with children positively. Additionally, staff were observed singing with children. Allegations regarding nurturing in an appropriate manner are addressed as follows: There are concerns the facility did not provide nurturing in an appropriate manner. § 110 91. Mandatory standards for a license. All child care facilities shall comply with all State laws and federal laws and local ordinances that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the standards in this section shall be complied with by all child care facilities. However, none of the standards in this section apply to the school age children of the operator of a child care facility but do apply to the preschool age children of the operator. Children 13 years of age or older may receive child care on a voluntary basis provided all applicable required standards are met. The standards in this section, along with any other applicable State laws and federal laws or local ordinances, shall be the required standards for the issuance of a license by the Secretary under the policies and procedures of the Commission except that the Commission may, in its discretion, adopt less stringent standards for the licensing of facilities which provide care on a temporary, part time, drop in, seasonal, after school or other than a full time basis (10) Each operator or staff member shall attend to any child in a nurturing and appropriate manner, and in keeping with the child's developmental needs. Each child care facility shall have a written policy on discipline, describing the methods and practices used to discipline children enrolled in that facility. This written policy shall be discussed with, and a copy given to, each child's parent prior to the first time the child attends the facility. Subsequently, any change in discipline methods or practices shall be communicated in writing to the parents prior to the effective date of the change. The use of corporal punishment as a form of discipline is prohibited in child care facilities and may not be used by any operator or staff member of any child care facility, except that corporal punishment may be used in religious sponsored child care facilities as defined in G.S. 110 106, only if (i) the religious sponsored child care facility files with the Department a notice stating that corporal punishment is part of the religious training of its program, and (ii) the religious sponsored child care facility clearly states in its written policy of discipline that corporal punishment is part of the religious training of its program. The written policy on discipline of nonreligious sponsored child care facilities shall clearly state the prohibition on corporal punishment Staff were observed providing nurturing, attentive, and developmentally appropriate care to the children. Staff members were interviewed regarding the allegation. All staff present during today’s visit stated they were not aware of any incidents involving staff yelling at toddlers. Staff provided examples of situations in which a raised voice may be used appropriately, such as during an emergency. For example, if two (2) children were fighting over a toy and one child was about to bite another, a teacher may raise their voice briefly to prevent injury and gain the child’s immediate attention. Additionally, one (1) staff member who was not present during today’s visit was interviewed by phone and stated they were not aware of any staff members yelling at toddlers. The staff member explained that if a toddler is engaging in inappropriate behavior, they would ask the child to stop and provide redirection as needed. The Behavior Management Policy used at the facility and signed acknowledgements by parents/families states that: No child shall be subjected to any form of corporal punishment. Praise and positive reinforcement are effective methods of the behavior management of children. When children receive positive, non-violent, and understanding interactions from adults and others, they develop good self-concepts, problem solving abilities, and self-discipline. Based on this belief of how children learn and develop values, this facility will practice the following age and developmentally appropriate discipline and behavior management policy They: DO NOT handle children roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking. DO NOT place children in a locked room, closet, or box or leave children alone in a room separated from staff. DO NOT delegate discipline to another child. DO NOT withhold food as punishment or give food as a means of reward. DO NOT discipline for toileting accidents. DO NOT discipline for not sleeping during rest period. DO NOT discipline children by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms, floors, or emptying diaper pails. 8. DO NOT withhold or require physical activity, such as running laps and doing push-ups, as punishment. DO NOT yell at, shame, humiliate, frighten, threaten, or bully children. DO NOT restrain children as a form of discipline unless the child’s safety or the safety of others is at risk. During our observation in the toddler classroom, staff were observed interacting with children in a calm appropriate manner. No instances of yelling were observed during the visit. Based on the interview and observation conducted during the visit the allegations regarding safe environment staff/child interactions, and nurturing in an appropriate manner were unsubstantiated. Staff/child ratios during the visit were as follows: Space #1 – two (2) staff and fifteen (15) children ages two through four years. Space #2A – one (1) staff and five (5) infant through one year old children. Space #2B – one (1) staff and six (6) children ages one and two years. The CAP was monitored for compliance as follows: Item #1 – There were two (2) violations of child care requirements during the visit today. This item is not in compliance. Item #2- This item has been completed and is in compliance. Item #3- This item has been completed and is in compliance. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. Ms. Coffey emailed the plans for review on 2/26/26. The plans have been reviewed and revisions to the plan by Ms. Coffey are in process. The following violations were observed during the visit today. Violation Number Comment Rule 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. An infant in attendance on 2/13/26, from approximately 7:30am until approximately 5:00pm, did not have documentation that the teacher visually checked on the sleeping infant. .0606(g) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19). The prior notice administrative action and cover letter, dated 1/23/26, were not posted. 10A NCAC 09 .2201(i)(1-4) Technical Assistance Item #1948 You stated the legal operator, Kaitlyn Frady, had not provided you with the administrative action and cover letter to post. We provided you with a copy of the administrative action and cover letter during the visit. This was corrected during the visit. A final notice will be mailed soon. Plan to post the administrative action, cover letter, and provisional license once received. Once the provisional license is posted, the four-star license will need to be taken down. The four-star license will be collected at a future visit. Item #887 To achieve compliance, you stated you would continue what you started last week, which was to review the safe sleep charts each day. You are working on your final plan for safe sleep checks. Achieving Compliance: The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Name and position of individual submitting compliance statement • Date of visit • Violation item number • Signed statement of compliance I must receive your compliance statement by 03/16/2026 Email the compliance letter on signed letterhead or it must be sent from the email address registered with the DCDEE (this serves as your signature) to: bridget.owen@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Bridget Owen Po Box 114 Rosman, NC 28772 Please call me at 828-530-2424, or email bridget.owen@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 a training opportunity for staff working in the toddler classroom through Southwestern Child Development Commission titled “Stay With Me: Continuity of Care for Infants and Toddlers.” The administrator was informed that staff may register for this training using the link provided below: https://reg.learningstream.com/reg/event_page.aspx?ek=0042-0007-cdd687d70bdf4c00b15fa6d39d1a04f6. Discussion included the importance of maintaining a calm and developmentally appropriate tone of voice when addressing toddlers. It was reviewed that raising one’s voice, even when redirecting behavior, may cause distress and is not considered a positive guidance technique. Examples of appropriate guidance strategies were discussed, including: • Getting down to the child’s eye level before giving directions • Using a calm, clear voice when providing redirection • Offering simple, age-appropriate instructions (e.g., “Feet on the floor” instead of repeated directives) • Using positive phrasing (e.g., “Please sit on your bottom” rather than “Stop it”) • Redirecting children to another activity when behaviors escalate • Modeling expected behavior • Using proximity and gentle reminders rather than raised voice volume The importance of consistent classroom management strategies and staff self-awareness regarding tone and volume was emphasized. The administrator was encouraged to review positive guidance policies with all staff and provide additional training if needed. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. The violation(s) documented must be corrected immediately. I must receive a written, dated, and signed compliance letter that describes accurately and in detail, how and when the violations were corrected. Please be aware any information submitted by you is legal documentation. If it is determined the information provided in the letter is not true, this may be considered falsification of information. If sufficient information is not received by the due date, a follow-up visit will be conducted. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable to your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and can be a resource for you while you strive to provide a safe and healthy environment for the well-being of young children. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at bridget.owen@dhhs.nc.gov or 828.530-2424 or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0701 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/29/2026 Number Present: 25 Completed Date: 1/29/2026 Age: From 0 To 4 Total Minutes: 130 Time In: 01:20 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on violations cited during the administrative action follow-up visit on 1/14/26. A letter of compliance was received on 1/28/26 and did not clearly indicate that all violations were corrected. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, Ms. Coffey was the second staff to maintain staff/child ratios in space #2A, the classroom with infants and one year old children. The administrative action, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The four-star license dated 12/31/25 was not posted and a reprint has been requested by the legal operator, as well as a mailing address change. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. A letter of compliance was received by Ms. Coffey via email on 1/28/26. The violations cited on 1/14/26 were monitored for compliance that were not clearly addressed in the letter of compliance. Item #1805 – The letter of compliance was sent by Ms. Coffey via email on 1/28/26 and stated “The employees were still working on adding them to the ABCMS interface on the day of the visit. In order to add staff members to the portal, the administrator is carefully collaborating with them to obtain their usernames and last names.” Upon arrival, K. H.-Moss was on-site working at the facility and counted in staff/child ratio in space #2B. Item #1032 – The letter of compliance sent by Ms. Coffey via email on 1/28/26 and stated “Medical records were missing from the staff. The staff was informed that she could not come back until we had her medical records. We now adhere to the checklist found on the division’s website.” When Ms. Moss was asked what days she worked this week, she replied every day except Monday. This would have Ms. Moss as working on Tuesday, Wednesday, and today this week. Item #1033 – The letter of compliance sent by Ms. Coffey via email on 1/28/26 and stated “TB screening was absent among the staff. The staff was informed that she could not come back until we had her medical records. We now adhere to the checklist found on the division’s website.” When Ms. Moss was asked what days she worked this week, she replied every day except Monday. This would have Ms. Moss as working on Tuesday, Wednesday, and today this week. Item #1757 - The letter of compliance sent by Ms. Coffey via email on 1/28/26 and stated “Employees were unable to locate a qualified letter. Since then, employees are unable to return until the employee provides the letter.” When Ms. Moss was asked what days she worked this week, she replied every day except Monday. This would have Ms. Moss as working on Tuesday, Wednesday, and today this week. Ms. Moss provided the qualifying letter electronically on her phone during the visit and Ms. Coffey printed out the qualifying letter and placed in the employee’s file. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action provisional license was mailed on 1/23/26. This was prior to the mailing address change. If the administrative action is not received by 2/2/26, plan to let me know and the administrative action will be emailed to the legal operator and you for review. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during rest time, free play, and routine care. Staff/child ratios at rest time were as follows: Space #1 – one (1) staff and thirteen (13) children ages three through four years. Space #2A – two (2) staff and six (6) children ages infants through one year. Space #2B – one (1) staff and six (6) children ages two and three years. During rest time there was no person extra on-site to assist the teacher in space #1. The Corrective Action Plan was monitored as follows: Item #1 – Five (5) violations were observed today. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item has been completed. Item #3- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, via email on 1/28/26 to arrange for a technical assistance visit that will address maintaining compliance with requirements. This item is in process. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training and technical assistance visit. The following violations of child care requirements observed today: Violation Number Comment Rule 317 The staff/child ratios for children, two years and older, during naptime were not maintained by having at least one person in each room, visually supervising all children and the total number of required staff on the premises within calling distance of each room occupied by children. There was one (1) staff in space #1 with thirteen (13) resting children ages three through four years; staff/child ratio is 1:10. No person was available on-site within calling distance of space #1 that was occupied by children. .1801(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25 and 1/14/26. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25 and 1/14/26. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25 and 1/14/26. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of five (5) of the six (6) staff at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25 and 1/14/26. G.S. 110-90.2 & .2703(r) 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 • Signed statement of compliance I must receive your compliance statement on or before 2/12/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The facility compliance history prior to the visit today was eighty-two percent (82%). Achieving Compliance – rule references are noted in the cited violations Supervision at Rest Time - Item #317 To achieve compliance, a plan must be created to discuss how rest time will be in compliance with supervision requirements. We discussed in the future to have more children added to one classroom and keep the other classroom within the required ratio if only no person is on-site and within calling distance to the room occupied by children. Within approximately sixteen (16) minutes after my arrival, a parent picked up a child to allow for Ms. Coffey to leave space #2A and be the available person within calling distance of space #1. You stated you misunderstood the rule. A follow up visit may be conducted to verify compliance with this requirement. DCDEE Criminal Background Check (CBC) Qualifying Letter on File – Item #1757 *To achieve compliance, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. The qualifying letter was placed in the employee's file during the visit. This was corrected during the visit. Criminal Background Check Reporting of New and Terminated Staff – Item #1805 *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, P. Patterson, J.C. Whitlow, E. Hyatt, K. Moss, and M. Allison must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. We discussed that E. Hyatt may be completed once she returns from leave. This information would need to be included in your letter of compliance. Staff Medical Report – Item #1032 *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Consultation: Repeat violations may be considered a pattern of non-compliance and lead to a more stringent administrative action. Additional follow-up visits may be conducted. Falsification of any information may result in a revocation of the license. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/29/2026 Number Present: 25 Completed Date: 1/29/2026 Age: From 0 To 4 Total Minutes: 130 Time In: 01:20 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on violations cited during the administrative action follow-up visit on 1/14/26. A letter of compliance was received on 1/28/26 and did not clearly indicate that all violations were corrected. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, Ms. Coffey was the second staff to maintain staff/child ratios in space #2A, the classroom with infants and one year old children. The administrative action, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The four-star license dated 12/31/25 was not posted and a reprint has been requested by the legal operator, as well as a mailing address change. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. A letter of compliance was received by Ms. Coffey via email on 1/28/26. The violations cited on 1/14/26 were monitored for compliance that were not clearly addressed in the letter of compliance. Item #1805 – The letter of compliance was sent by Ms. Coffey via email on 1/28/26 and stated “The employees were still working on adding them to the ABCMS interface on the day of the visit. In order to add staff members to the portal, the administrator is carefully collaborating with them to obtain their usernames and last names.” Upon arrival, K. H.-Moss was on-site working at the facility and counted in staff/child ratio in space #2B. Item #1032 – The letter of compliance sent by Ms. Coffey via email on 1/28/26 and stated “Medical records were missing from the staff. The staff was informed that she could not come back until we had her medical records. We now adhere to the checklist found on the division’s website.” When Ms. Moss was asked what days she worked this week, she replied every day except Monday. This would have Ms. Moss as working on Tuesday, Wednesday, and today this week. Item #1033 – The letter of compliance sent by Ms. Coffey via email on 1/28/26 and stated “TB screening was absent among the staff. The staff was informed that she could not come back until we had her medical records. We now adhere to the checklist found on the division’s website.” When Ms. Moss was asked what days she worked this week, she replied every day except Monday. This would have Ms. Moss as working on Tuesday, Wednesday, and today this week. Item #1757 - The letter of compliance sent by Ms. Coffey via email on 1/28/26 and stated “Employees were unable to locate a qualified letter. Since then, employees are unable to return until the employee provides the letter.” When Ms. Moss was asked what days she worked this week, she replied every day except Monday. This would have Ms. Moss as working on Tuesday, Wednesday, and today this week. Ms. Moss provided the qualifying letter electronically on her phone during the visit and Ms. Coffey printed out the qualifying letter and placed in the employee’s file. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. A prior notice administrative action provisional license was mailed on 1/23/26. This was prior to the mailing address change. If the administrative action is not received by 2/2/26, plan to let me know and the administrative action will be emailed to the legal operator and you for review. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during rest time, free play, and routine care. Staff/child ratios at rest time were as follows: Space #1 – one (1) staff and thirteen (13) children ages three through four years. Space #2A – two (2) staff and six (6) children ages infants through one year. Space #2B – one (1) staff and six (6) children ages two and three years. During rest time there was no person extra on-site to assist the teacher in space #1. The Corrective Action Plan was monitored as follows: Item #1 – Five (5) violations were observed today. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item has been completed. Item #3- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, via email on 1/28/26 to arrange for a technical assistance visit that will address maintaining compliance with requirements. This item is in process. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training and technical assistance visit. The following violations of child care requirements observed today: Violation Number Comment Rule 317 The staff/child ratios for children, two years and older, during naptime were not maintained by having at least one person in each room, visually supervising all children and the total number of required staff on the premises within calling distance of each room occupied by children. There was one (1) staff in space #1 with thirteen (13) resting children ages three through four years; staff/child ratio is 1:10. No person was available on-site within calling distance of space #1 that was occupied by children. .1801(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25 and 1/14/26. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25 and 1/14/26. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25 and 1/14/26. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of five (5) of the six (6) staff at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25 and 1/14/26. G.S. 110-90.2 & .2703(r) 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 • Signed statement of compliance I must receive your compliance statement on or before 2/12/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The facility compliance history prior to the visit today was eighty-two percent (82%). Achieving Compliance – rule references are noted in the cited violations Supervision at Rest Time - Item #317 To achieve compliance, a plan must be created to discuss how rest time will be in compliance with supervision requirements. We discussed in the future to have more children added to one classroom and keep the other classroom within the required ratio if only no person is on-site and within calling distance to the room occupied by children. Within approximately sixteen (16) minutes after my arrival, a parent picked up a child to allow for Ms. Coffey to leave space #2A and be the available person within calling distance of space #1. You stated you misunderstood the rule. A follow up visit may be conducted to verify compliance with this requirement. DCDEE Criminal Background Check (CBC) Qualifying Letter on File – Item #1757 *To achieve compliance, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. The qualifying letter was placed in the employee's file during the visit. This was corrected during the visit. Criminal Background Check Reporting of New and Terminated Staff – Item #1805 *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, P. Patterson, J.C. Whitlow, E. Hyatt, K. Moss, and M. Allison must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. We discussed that E. Hyatt may be completed once she returns from leave. This information would need to be included in your letter of compliance. Staff Medical Report – Item #1032 *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Consultation: Repeat violations may be considered a pattern of non-compliance and lead to a more stringent administrative action. Additional follow-up visits may be conducted. Falsification of any information may result in a revocation of the license. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0514 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/20/2026 Number Present: 19 Completed Date: 1/20/2026 Age: From 0 To 4 Total Minutes: 140 Time In: 10:40 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the sixteen (16) violations cited during the administrative action follow-up visit on 1/14/26. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Ms. Coffey was in staff/child ratio with one and two year old children in space #2B upon arrival due to a teacher call out due to going into labor to have a baby. At approximately 11:00am, M. Allison, substitute teacher, arrived. Ms. Allison substituted in space #1 to allow P. Patterson, Lead Teacher, to go to the kitchen and prepare lunch. Upon arrival, the administrative action, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The four-star license dated 12/31/25 was not posted. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. During the visit, the sixteen (16) violations cited on 1/14/26 were monitored for compliance: Item #102 – The four-star license dated 12/31/25 was not posted. The Special Provisional license that expired on 12/30/25 was posted. You stated you are working with Kaitlin Frady, the legal operator, to arrange a day and time to collect the four-star license for it to be posted as required. A letter of compliance is due on or before 1/28/26. Item #428 – Current activity plans were posted in space #1, #2A, and #2B. This violation has been corrected. A letter of compliance is due on or before 1/28/26 to explain the plan of how current activity plans will be posted as required. Item #526 – The menu was posted. This violation has been corrected. A letter of compliance is due on or before 1/28/26 to explain the plan of how a current menu will be posted as required. Item #603 – The rugs in space #1 were on the floor to cover the cracks on the floor. This violation has been corrected. A letter of compliance is due on or before 1/28/26 to state how the rugs will be on the cracked floors in space #1 during operating hours with children in care. Item #805 – A written plan has not been provided to state how fire drills will be practiced monthly. A fire drill was documented as practiced on 1/19/26, and recorded on the emergency drill log. A letter of compliance is due on or before 1/28/26 to explain the plan of how fire drills will be practiced monthly and documented on the emergency drill log. Item #841 – The office was not locked during the visit today. This is a repeat violation. During the visit, the diaper cream and hand sanitizers were removed from the office. The diaper cream was placed above five feet in space #2A and the hand sanitizers were put in locked storage in the laundry room. A letter of compliance is due on or before 1/28/26 to state how diaper creams and hand sanitizers will be stored to make inaccessible to children to meet the on-going requirement. Item #887 – Sleep check documentation for 1/14/26 through today was reviewed during the visit. There was sleep documentation completed for the two infants enrolled. A letter of compliance is due on or before 1/28/26 to explain the plan of how sleep check documentation will be completed when infants sleep. Item #1032 – A staff medical report for the staff hired on 1/13/26 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the staff medical report is completed and on file. A letter of compliance is due on or before 1/28/26. Item #1033 – A TB test/screening for the staff hired on 1/13/26 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the TB test or TB screening is completed and on file. A letter of compliance is due on or before 1/28/26. Item #1043 – The staff file for E.H. was on-site and available for review during the visit today. This item has been corrected. During the review, the following items could not be located; documentation of orientation hours, staff emergency information form, signed job description, and signed acknowledgement of operational and personnel policies. This staff member went out on medical leave as today. A letter of compliance is due on or before 1/28/26 to explain how staff files will be easily located and available for review. Item #1757 – A DCDEE Criminal Background Check (CBC) qualifying letter for the staff hired on 1/13/26 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the DCDEE CBC qualifying letter is completed and on file. A letter of compliance is due on or before 1/28/26. Item #1805 – Zero (0) of the five (5) staff, M. Allison, P. Patterson, J.C. Whitlow, E. Hyatt, and K. Moss, have not been assigned to the child care facility in the ABCMS portal. Staff will need to be assigned to the child care facility in the ABCMS portal. A letter of compliance is due on or before 1/28/26. Item #1811 – A written statement has not been received as to how a shelter-in-place drill or lockdown drill will be completed every three months. A shelter-in-place drill was documented as being practiced on 1/19/26 and recorded on the emergency drill log. A letter of compliance is due to be received on or before 1/28/26 to explain the plan of how shelter-in-place drills or lockdown drills will be practiced and documented every three months. Item #1874 – The signed acknowledgement for the prevention of shaken baby and abusive head trauma policy for the staff hired on 1/13/26 was on file. This violation is in compliance. A letter of compliance is due on or before 1/28/26. Item #1898 – Staff members L.C., P.P., and C.W. had all required health and safety training certificates on file during the visit today. This violation is in compliance. A letter of compliance is due on or before 1/28/26. Item #1948 – The administrative action, cover letter, and corrective action plan were posted. This item has been corrected and is in compliance. A letter of compliance is due on or before 1/28/26. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor has been updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed in free play, and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and nine (9) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and six (6) children ages one and two years. The Corrective Action Plan was monitored as follows: Item #1 – Four (4) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional four bottles of hand sanitizer were stored below five feet. This is a repeat violation from 1/14/26. 15A NCAC 18A .2820(d) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. One (1) staff, hired on 10/23/25, did not have an emergency information form on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, hired on 10/23/25, had a new staff orientation form without any documentation of the number of hours received for each topic. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. One (1) staff, hired on 10/23/25, did not have a signed and dated statement that they received a job description or that she reviewed personnel and operational policies. 10A NCAC 09 .0514(g) 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 • Signed statement of compliance I must receive your compliance statement on or before 2/3/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Achieving Compliance – rule references are noted in the cited violations Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer and diaper cream must be stored at five feet or higher, or locked. A permission form was completed during the visit and the diaper cream was moved to space #2A above five feet. The hand sanitizers were moved to the laundry room locked storage. This is a repeat violation from 1/14/26. Repeat violations may be considered a pattern of non-compliance. Item #1045 *To achieve compliance, the number of hours of orientation provided to E.H. must be documented on the new staff orientation form. Also plan to document who provided the training to the staff on the new staff orientation form. The new staff orientation form will need to be emailed to the child care consultant for review. In the letter of compliance, plan to detail how you will accurately keep up with the number of training hours new staff receive for orientation. Item #1233 *To achieve compliance, the job description and acknowledgement that the staff has reviewed the operational and personnel policies must be signed and dated. E.H. went out on medical leave as of today. We discussed that E.H. would need to complete these items on the first day after returning from medical leave. Plan to detail in the letter of compliance the date you anticipate E.H. returning to work and the plan to have her sign and date what is required. Item #1035 *To achieve compliance, the staff emergency information form must be completed and on file. E.H. went out on medical leave as of today. We discussed that E.H. would need to complete the form on the first day after returning from medical leave. Plan to detail in the letter of compliance the date you anticipate E.H. returning to work and the plan to have her complete what is required. Consultation: The visit summary addendum dated 1/15/26 was printed and placed with your visit summary from 1/14/26 during the visit. Repeat violations may be considered a pattern of non-compliance and lead to a more stringent administrative action. Additional follow-up visits may be conducted. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/20/2026 Number Present: 19 Completed Date: 1/20/2026 Age: From 0 To 4 Total Minutes: 140 Time In: 10:40 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the sixteen (16) violations cited during the administrative action follow-up visit on 1/14/26. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Ms. Coffey was in staff/child ratio with one and two year old children in space #2B upon arrival due to a teacher call out due to going into labor to have a baby. At approximately 11:00am, M. Allison, substitute teacher, arrived. Ms. Allison substituted in space #1 to allow P. Patterson, Lead Teacher, to go to the kitchen and prepare lunch. Upon arrival, the administrative action, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The four-star license dated 12/31/25 was not posted. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. During the visit, the sixteen (16) violations cited on 1/14/26 were monitored for compliance: Item #102 – The four-star license dated 12/31/25 was not posted. The Special Provisional license that expired on 12/30/25 was posted. You stated you are working with Kaitlin Frady, the legal operator, to arrange a day and time to collect the four-star license for it to be posted as required. A letter of compliance is due on or before 1/28/26. Item #428 – Current activity plans were posted in space #1, #2A, and #2B. This violation has been corrected. A letter of compliance is due on or before 1/28/26 to explain the plan of how current activity plans will be posted as required. Item #526 – The menu was posted. This violation has been corrected. A letter of compliance is due on or before 1/28/26 to explain the plan of how a current menu will be posted as required. Item #603 – The rugs in space #1 were on the floor to cover the cracks on the floor. This violation has been corrected. A letter of compliance is due on or before 1/28/26 to state how the rugs will be on the cracked floors in space #1 during operating hours with children in care. Item #805 – A written plan has not been provided to state how fire drills will be practiced monthly. A fire drill was documented as practiced on 1/19/26, and recorded on the emergency drill log. A letter of compliance is due on or before 1/28/26 to explain the plan of how fire drills will be practiced monthly and documented on the emergency drill log. Item #841 – The office was not locked during the visit today. This is a repeat violation. During the visit, the diaper cream and hand sanitizers were removed from the office. The diaper cream was placed above five feet in space #2A and the hand sanitizers were put in locked storage in the laundry room. A letter of compliance is due on or before 1/28/26 to state how diaper creams and hand sanitizers will be stored to make inaccessible to children to meet the on-going requirement. Item #887 – Sleep check documentation for 1/14/26 through today was reviewed during the visit. There was sleep documentation completed for the two infants enrolled. A letter of compliance is due on or before 1/28/26 to explain the plan of how sleep check documentation will be completed when infants sleep. Item #1032 – A staff medical report for the staff hired on 1/13/26 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the staff medical report is completed and on file. A letter of compliance is due on or before 1/28/26. Item #1033 – A TB test/screening for the staff hired on 1/13/26 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the TB test or TB screening is completed and on file. A letter of compliance is due on or before 1/28/26. Item #1043 – The staff file for E.H. was on-site and available for review during the visit today. This item has been corrected. During the review, the following items could not be located; documentation of orientation hours, staff emergency information form, signed job description, and signed acknowledgement of operational and personnel policies. This staff member went out on medical leave as today. A letter of compliance is due on or before 1/28/26 to explain how staff files will be easily located and available for review. Item #1757 – A DCDEE Criminal Background Check (CBC) qualifying letter for the staff hired on 1/13/26 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the DCDEE CBC qualifying letter is completed and on file. A letter of compliance is due on or before 1/28/26. Item #1805 – Zero (0) of the five (5) staff, M. Allison, P. Patterson, J.C. Whitlow, E. Hyatt, and K. Moss, have not been assigned to the child care facility in the ABCMS portal. Staff will need to be assigned to the child care facility in the ABCMS portal. A letter of compliance is due on or before 1/28/26. Item #1811 – A written statement has not been received as to how a shelter-in-place drill or lockdown drill will be completed every three months. A shelter-in-place drill was documented as being practiced on 1/19/26 and recorded on the emergency drill log. A letter of compliance is due to be received on or before 1/28/26 to explain the plan of how shelter-in-place drills or lockdown drills will be practiced and documented every three months. Item #1874 – The signed acknowledgement for the prevention of shaken baby and abusive head trauma policy for the staff hired on 1/13/26 was on file. This violation is in compliance. A letter of compliance is due on or before 1/28/26. Item #1898 – Staff members L.C., P.P., and C.W. had all required health and safety training certificates on file during the visit today. This violation is in compliance. A letter of compliance is due on or before 1/28/26. Item #1948 – The administrative action, cover letter, and corrective action plan were posted. This item has been corrected and is in compliance. A letter of compliance is due on or before 1/28/26. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor has been updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed in free play, and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and nine (9) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and six (6) children ages one and two years. The Corrective Action Plan was monitored as follows: Item #1 – Four (4) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional four bottles of hand sanitizer were stored below five feet. This is a repeat violation from 1/14/26. 15A NCAC 18A .2820(d) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually. One (1) staff, hired on 10/23/25, did not have an emergency information form on file. .0701(a) 1045 New staff, who had contact with children, did not receive at least 16 hrs. orientation within first 6 weeks. One (1) staff, hired on 10/23/25, had a new staff orientation form without any documentation of the number of hours received for each topic. .1101(a) 1233 Each employee's personnel file did not contain a signed and dated statement that they received a job description and that they have received personnel and operational policies. One (1) staff, hired on 10/23/25, did not have a signed and dated statement that they received a job description or that she reviewed personnel and operational policies. 10A NCAC 09 .0514(g) 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 • Signed statement of compliance I must receive your compliance statement on or before 2/3/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Achieving Compliance – rule references are noted in the cited violations Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer and diaper cream must be stored at five feet or higher, or locked. A permission form was completed during the visit and the diaper cream was moved to space #2A above five feet. The hand sanitizers were moved to the laundry room locked storage. This is a repeat violation from 1/14/26. Repeat violations may be considered a pattern of non-compliance. Item #1045 *To achieve compliance, the number of hours of orientation provided to E.H. must be documented on the new staff orientation form. Also plan to document who provided the training to the staff on the new staff orientation form. The new staff orientation form will need to be emailed to the child care consultant for review. In the letter of compliance, plan to detail how you will accurately keep up with the number of training hours new staff receive for orientation. Item #1233 *To achieve compliance, the job description and acknowledgement that the staff has reviewed the operational and personnel policies must be signed and dated. E.H. went out on medical leave as of today. We discussed that E.H. would need to complete these items on the first day after returning from medical leave. Plan to detail in the letter of compliance the date you anticipate E.H. returning to work and the plan to have her sign and date what is required. Item #1035 *To achieve compliance, the staff emergency information form must be completed and on file. E.H. went out on medical leave as of today. We discussed that E.H. would need to complete the form on the first day after returning from medical leave. Plan to detail in the letter of compliance the date you anticipate E.H. returning to work and the plan to have her complete what is required. Consultation: The visit summary addendum dated 1/15/26 was printed and placed with your visit summary from 1/14/26 during the visit. Repeat violations may be considered a pattern of non-compliance and lead to a more stringent administrative action. Additional follow-up visits may be conducted. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0701 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0901 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2201 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-99 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
GS 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/14/2026 Number Present: 18 Completed Date: 1/14/2026 Age: From 0 To 4 Total Minutes: 100 Time In: 10:05 AM Time Out: 11:15 AM Time In: 01:45 PM Time Out: 02:15 PM List to Use: Center Type Of Visit: Admin Action Follow-Up Lic Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on the administrative action written warning that was issued to the facility on 12/5/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the four-star license, administrative action written warning, cover letter, and corrective action plan were not posted at the entry where it could be viewed by parents and visitors. Due to connectivity issues, the visit summary report was completed off-site. The following was monitored during the visit, including, but not limited to: o Supervision of children; o Discipline, nurture, or care of children; o Staff/child ratio; o Group size; o Licensed capacity; o Permit restriction; o CPR/First Aid training; o First Aid training; o ITS-SIDS training; and o Criminal record check requirements regarding pre-service and three-year reassessments The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as administratively dissolved on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlin Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. A notice of the business being administratively dissolved was sent to Ms. Frady on 12/12/25 from NCSOS. The licensing supervisor will be updated on the status of the corporation. If the facility is not in good standing with the NCSOS, or NC Department of Revenue, an administrative action may be issued. An intent to change ownership was received from Ms. Frady Frady via email on 1/5/26. An ownership change cannot be considered until Tiny Toes Learning Center Hayesville LLC is reinstated through the NCSOS and listed as active-current. The children were observed during free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and ten (10) children ages three through four years. Space #2A – one (1) staff and four (4) children ages infant through one year. Space #2B – one (1) staff and four (4) children ages one and two years. We monitored for compliance with the CAP as follows: Item #1 – sixteen (16) violations were observed today related to the requirements included in this stipulation. This item is not in compliance. Item #2- Ms. Coffey contacted Monica Houck, Lead Child Care Consultant, to schedule the required rules review training. The rules review training is scheduled for 1/23/26. This item is in process. Item #3- Within one (1) week after the required review of all child care requirements is completed, Ms. Coffey shall contact Ms. Houck to arrange for a technical assistance visit that will address maintaining compliance with requirements. Special emphasis shall be placed on violations documented in this notice. This must be completed after the rules review training. Item #4- Within two (2) weeks after the complete review of all child care requirements and the technical assistance visit is completed, Ms. Coffey, shall develop the facility’s written plan to describe, in detail, the steps the facility will take to ensure compliance with criminal background checks (CBC), ITS-SIDS training, in-service training, special training, general safety with safe sleep checks, age appropriate activities/activity plans, and nutrition/menus, as well as maintaining accurate staff and program records at all times. This must be completed after the rules review training. The following violations of child care requirements observed today: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. The four-star license for the facility was not posted. The Special Provisional license that expired on 12/30/25 was posted. G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted for each group of children for reference Activity Plan not posted. This is a repeat violation from 10/23/25 and 10/29/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted where it could be reviewed by food preparation staff or by parents. This is a repeat violation from 10/23/25 and 10/29/25. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #3, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed. This is a repeat violation from 10/23/25. 15A NCAC 18A .2824(a)&(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. Fire Drills were not conducted or documented on the drill log for November and December 2025. This is a repeat violation from 10/23/25. .0604(t); .0302(d)(5) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Administrator office door was unlocked, and Walgreen Baby diaper cream was below five feet. Additional three bottles of hand sanitizer were stored below five feet. 15A NCAC 18A .2820(d) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Caregivers did not document compliance with visually checking on sleeping infant aged 12 months or younger and/or the documents were not maintained for a minimum of one month. Safe sleep checks were not conducted for one child. The last recorded sleep check was completed on January 08, 2026. This is a repeat violation from 10/23/25 and 10/29/25. .0606(g) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. .0701(a) 1043 All staff records, except financial records, were not made available for review. The staff file for E.H. could not be located during the visit. G.S. 110-91( 9) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 1/13/26 and there was not a CBC qualifying letter on file at the facility. This is a repeat violation from 10/23/25. G.S. 110-90.2(b) & (d) & .2703(e) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of four (4) of the five (5) staff that are hired at the child care facility by assigning them in the ABCMS portal. This is a repeat violation from 10/23/25. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place or lockdown drill was not completed or documented in December 2025. This is a repeat violation from 10/23/25. .0604(u);.0302(d)(8) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. .0608(d)(1-4) 1898 Staff did not complete the health and safety training within one year of employment. Health and Safety training certificates for three staff were not on file for review. .1102(a) 1948 Following the issuance of any administrative action the operator did not post the administrative action, cover letter, and/or corrective action plan, if applicable, in a location visible to parents and visitors near the entrance of the child care facility during the pendency of an appeal and/or throughout the effective time period of the administrative action. (Applicable to administrative actions after 2/1/19) The administrative action, cover letter, and corrective action plan were not posted. 10A NCAC 09 .2201(i)(1-4) 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 • Signed statement of compliance I must receive your compliance statement on or before 1/28/26. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The compliance history score for the facility prior to today’s visit was eighty-five percent (85%). Achieving Compliance – rule references are noted in the cited violations DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance for item #1757, Kendra Hensley-Moss must have a DCDEE CBC qualifying letter on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. *To allow for verification of compliance from the 10/23/25 annual compliance visit, at least one (1) staff had to be assigned to the facility in the Automated Background Check Management System (ABCMS) portal. It was verified on 11/14/25 that Lily Coffey, Administrator, assigned herself to the facility in the ABCMS portal. We discussed you were to continue with the process of assigning staff to the ABCMS portal after you understood the process. To achieve compliance for violation item #1805 cited today, the remaining four (4) staff must be assigned to the facility in the ABCMS portal. We discussed that any new staff hired must be assigned to the facility within five (5) business days in the ABCMS portal. Assigning staff in the ABCMS portal is an important tool to assist in keeping children safe. Item #841 *To achieve compliance, the office door must be locked if any hazardous products are not locked or above five feet. In classrooms, hand sanitizer must be stored at five feet or higher, or locked. Reminder that handwashing is required when soap and water is available. Item #887 *To achieve compliance, safe sleep checks must be documented while children twelve months old or younger are sleeping. A plan must be provided from you to state how sleep charts will be completed when infants are sleeping. It is recommended that you review the sleep charts periodically throughout the day to ensure they are completed and to help staff understand the importance of checking on sleeping infants. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Once another teacher arrived, a sleep chart for the child was located or created for 1/9/26 and 1/12/26. You stated the child was not in attendance on 1/13/26. Item #102 *To achieve compliance, the four-star license must be posted for the facility where it can be seen by parents and visitors. We discussed you will need to get the four-star license that was issued on 12/30/25 from the legal operator, Ms. Frady. Item #1948 *To achieve compliance, the administrative action, cover letter, and corrective action plan must be posted where it can be seen by parents and visitors. Item #805 *To achieve compliance, a fire drill must be conducted, and a plan must be provided to state how fire drills will be completed monthly. We discussed keeping a drill reminder on your phone. Children must have monthly opportunities to practice a fire drill to ensure safe evacuation in an emergency. Item #1811 *To achieve compliance, a shelter-in-place or lockdown drill must be conducted. We discussed keeping a drill reminder on your phone. Children must have opportunities every three months to practice a shelter-in-place or lockdown drill to better understand how to respond in an emergency. Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. You completed the activity plan for space #1. Item # 1898-Health and Safety training certificates for three staff were not on file for review. *To achieve compliance, all completed health and safety training certificates for L.C., J.C.W., and P.P. must be on file. Item #1043 *To achieve compliance, the file for E.H. must be provided for review. Additional violation may be cited once the staff file is reviewed. Staff Medical Report – Item #1032 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a staff medical report. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. *TB Test/Screening – Item #1033 One (1) staff member, that was reported to have begun employment on 1/13/26, did not have documentation of completing a TB test or TB screening. This is a repeat violation from 10/23/25. *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. *Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 One (1) staff member was reported to have begun employment on 1/13/26, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. This is a repeat violation from 10/23/35. *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Item #603 *To achieve compliance, the floor cracks must be covered with rugs. Clay County Environmental Health is allowing the floor to be covered by rugs as long as they are vacuumed daily and cleaned at least every six months or more often if needed. The rugs were placed on the floor during the visit. Consultation: Additional follow-up visits may be conducted. There were multiple repeat violations, which show a pattern of non-compliance. If a pattern of non-compliance is determined, it may result in a more stringent administrative action for the facility. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed the special windows with the county. You stated today there are plans to replace the windows, but do not have a timeline for replacement. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0901 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/29/2025 Number Present: 16 Completed Date: 10/29/2025 Age: From 0 To 4 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on twenty-three (23) violations cited during the annual compliance visit on 10/23/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. During the visit, the twenty-three (23) violations cited on 10/23/25 were monitored for compliance: Item #106 – A written plan has not been provided to state how fire inspections will be completed within 12 months of the previous inspection. We discussed that you plan have this on your reoccurring electronic calendar to contact the Fire Marshal prior to the inspection needing to be completed. A letter of compliance must be received on or before 11/6/25. Item #415 – This was corrected during the visit on 10/23/25. Item #428 – Current activity plans were not posted in space #1, #2A, and #2B. This is a repeat violation. Item #526 – The menu was not posted during the visit today. This is a repeat violation. Item #603 – You stated you have discussed the floor repairs needed with Clay County Department of Social Services (DSS), the owner of the building. We discussed you will also need to contact Clay County Environmental Health to determine how the exposed concrete on the floor can be repaired. A letter of compliance must be received on or before 11/6/25. Item #604 – The bathroom outside of space #1 was free of storage. This violation has been corrected and is in compliance. Item #721 – This was corrected during the visit on 10/23/25. Item #805 – A written plan has not been provided to state how fire drills will be practiced monthly. We discussed the person in charge, P.P., will be responsible for completing the monthly fire drill during your absence. A letter of compliance is due on or before 11/6/25. Item #840 – This item was corrected during the visit on 10/23/25. Item #858 – This item was corrected during the visit on 10/23/25. Item #859 – A written plan has not been provided to state how playground inspections will be completed monthly. We discussed the person in charge, P.P., will take playground safety training to complete the monthly playground inspections during your absence. A letter of compliance is due on or before 11/6/25. Item #887 – Sleep check documentation for 10/23/25 through today was reviewed during the visit. There was no sleep documentation completed for yesterday, 10/28/25. This is a repeat violation. Item #1030 – An application for employment for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the application is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1032 – A staff medical report for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the staff medical report is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1033 – A TB test/screening for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the TB test or TB screening is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1757 – A DCDEE Criminal Background Check (CBC) qualifying letter for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the DCDEE CBC qualifying letter is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1805 – Staff have not been assigned to the child care facility in the ABCMS portal. You provided the certificate of completion for the ABCMS training in the DCDEE Moodle. Staff will need to be assigned to the child care facility in the ABCMS portal. A letter of compliance is due on or before 11/6/25. Item #1795 – You thought there was an approved curriculum on-site; The Creative Curriculum® for Preschool, 4th Edition, Teaching Strategies, Inc., 2002. However, you stated that you will need to contact the owner to have the curriculum located, on-site, and implemented. The curriculum must be implemented with four year old children. The letter of compliance is due on or before 11/6/25. Item #1811 – A written statement has not been received as to how a shelter-in-place drill or lockdown drill will be completed every three months. We discussed the person in charge, P.P., will be responsible for completing the shelter-in-place drill or lockdown drill during your absence. A letter of compliance is due to be received on or before 11/6/25. Item #1831 – Upon arrival, the administrator was caring for the infants in space #2A, the classroom with infant and one year old children. At approximately 10:15am, staff M.A. arrived and began caring for the infants in space #2A. You stated that you and P.P. are scheduled to complete the ITS-SIDS training today at 6pm. C.W. is scheduled to complete the ITS-SIDS training on 11/10/25. The registration for the two (2) ITS-SIDS trainings scheduled for today at 6pm were verified during the visit. The staff M.A. has valid ITS-SIDS training. A letter of compliance is due on or before 11/6/25. Item #1874 – The signed acknowledgement for the prevention of shaken baby and abusive head trauma policy for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the prevention of shaken baby and abusive head trauma has been reviewed with the staff and the acknowledgement is on file. A letter of compliance is due on or before 11/6/25. Item #1897 – Staff member C.W. must complete Recognizing and Responding to Suspicions of Child Maltreatment training. This is an on-demand training that can be taken at any time, and can be located https://www.preventchildabusenc.org/online-trainings/. A letter of compliance is due on or before 11/6/25. Item #1898 – Staff members L.C., P.P., and C.W. must complete all required topics for the health and safety trainings. The DCDEE Moodle platform, https://www.dcdee.moodle.nc.gov/, offers the trainings for free and the trainings can be completed at any time since they are on-demand. A letter of compliance is due on or before 11/6/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; The children were observed in free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and eight (8) children ages two through four years. Space #2A – one (1) staff and two (2) infants and one (1) one year old child. Space #2B – one (1) staff and five (5) children ages one and two years. During the annual compliance visit, the following items were not monitored due to time constraints. These items were monitored during the visit today. *The First Aid Poster was hanging where it was not visible. The teacher in space #2B turned the poster around from the CPR side to the First Aid side. *The tobacco restriction was not posted at the entry of the facility. *Incident Log - The last entry date on the incident log was 7/10/24. In addition, the fire evacuation routes were reviewed during the visit today. 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 observed today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. This is a repeat violation from 10/23/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. This is a repeat violation from 10/23/25. 10A NCAC 09 .0901(b) 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Incident reports are being stored with the incident log and not in children’s files. .0802 (e) 853 Incident logs were not completed and maintained as required. The last incident report documented on incident log was dated 7/10/24. .0802(g)(1-6) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the infants in care yesterday, 10/28/25. This is a repeat violation from 10/23/25. .0606(g) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Based on the North Carolina Fire Inspection report, the following NC fire codes are not being met for space #2A, the classroom with infant and one year old children: #19 – Exits free of obstructions – a shelf is placed in front of the exit door; and #25 – All exits and their access (i.e. aisles and corridors) free of obstructions – the passageway outside of space #2A has discarded toys and equipment leaving the exit route partially blocked. GS 110-91 1850 Signage was not posted regarding the smoking and tobacco restriction at the entrance of the center and/or in vehicles used to transport children. A smoking and tobacco restriction poster was not posted at the entrance of the center. .0604(i) 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 • Signed statement of compliance I must receive your compliance statement on or before 11/12/25. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Achieving Compliance – rule references are noted in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, safe sleep checks will be documented while children twelve months old or younger are sleeping. It is recommended that you review this requirement with all staff working in the infant classroom. It is also recommended that you review the sleep charts periodically throughout the day to ensure they are completed. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Activity Plans – Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. It is recommended to have activity plans posted at the end of the day on Fridays for the next week. You completed the activity plans during the visit and posted them in their respective classrooms, spaces #1, #2A, and #2B. This was corrected during the visit. Menu Posted – Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. We also discussed that a two week rotating menu would help with identifying a shopping list and have the menus prepared for posting at all times. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. You posted the menu dated 10/27/25 through 10/31/25 during the visit. This was corrected during the visit. NC Fire Codes – Item #899 *To achieve compliance, the shelf in space #2A needs to be removed from the exit door area and storage needs to be cleared from the passageway leading from space #2A to the exterior of the building to allow for safe exiting of children in case of an emergency. You moved the shelf in space #2A to allow for access to the exit door to the outside. You also moved the toys and furniture to a place inaccessible to children that was blocking the exit pathway outdoors. This was corrected during the visit. Incident Reports – Item #852 *To achieve compliance, the incident reports stored with the incident logs must be filed in the respective children’s files. All future incident reports would be documented on the incident log and then filed in the child’s file. It is recommended to provide this task to a staff member during nap time to allow you to complete other administrative duties. Incident Log - Item #853 *To achieve compliance, the incident reports dated 10/31/24 through 9/22/25 must be documented on the incident log. You documented the incident reports from 10/31/24 through 9/22/25 on the incident log during the visit. This was corrected during the visit. It is recommended to have staff log the incident report and then you file the incident report in the child's file once reviewed. Smoking and Tobacco Restriction Poster - Item #1850 *We discussed you can find the smoking and tobacco restriction poster at the NC Health and Safety Resource Center online for an updated version. You posted the smoking and tobacco restriction poster on the parent board during the visit. This item was corrected during the visit. Consultation: Due to the number of violations, an administrative action may be recommended for the child care facility. Additional follow-up visits may be conducted. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed this with the county. It is recommended to implement staff training plans that help staff understand how many on-going training hours they need annually and what resources they have to take approved trainings. L.C. is required to have eight (8) ongoing training hours each year and is due to complete the 2024-2025 ongoing training hours on or before 12/1/25. P.P. is required to have ten (10) ongoing training hours each year and is due to complete the 2025-2026 ongoing training hours on or before 1/17/26. We discussed ideas for having staff complete trainings. This could be having staff coming in early, staying late, and/or completing during naptime if there is a substitute available that would allow for them to go to the office to complete required trainings. Ms. Owen followed up with the you regarding your thoughts on Quality Rating Improvement System (QRIS) and which pathway you would like to pursue for the star-rated license. You stated you would like to choose Pathway Two (2) Classroom and Instructional Quality. I explained that this pathway requires an approved curriculum across all age groups along with an approved formative assessment. You stated you understood and asked if you could use different approved curriculums among the age groups, yes. You were informed that you would need to complete both the facility and individual CQI. She acknowledged understanding. We also discussed the Assessment Outreach option, which could be beneficial for you and the program in completing the CQI. Additionally, we discussed that the QRIS application -Application for Assessment for a Rated License Centers with embedded links can be found on the DCDEE website, and that the NCRLAP link will be included with this information. It was discussed that you need to begin this process as soon as possible due to the timeframe for the implementation of this process. https://ncrlap.org/ Timeline for Rated License October- March determining which pathway is best for the facility and begin reviewing resources and begin self-study, CQI April- through September Submit Rated License application Resources: Southwestern Child Development Commission Child Care Resource and Referral - swcdcinc.org/ North Carolina Rated License Assessment Project (NCRLAP) – ncrlap.org North Carolina Health and Safety Resource Center – healthychildcare.unc.edu National Resource Center for Health and Safety in Child Care and Early Education – ncrkids.org Child Care Health Consultant, Mary Ramirez, Mary.ramirez@unc.edu or 828-338-8330 Ms. Owen reviewed the evacuation process with all staff present today. Each staff member was able to identify a primary and secondary exit, and one staff member provided a third option. I discussed and suggested to you, the importance of developing a posted evacuation route for each classroom that clearly defines both a primary and secondary exit. The four-star rated license dated 6/1/24 and temporary license dated 12/1/23 through 6/1/24 was collected and will be mailed to DCDEE in Raleigh. We discussed that you can request a technical assistance visit if you have specific child care rules you would like to review and understand better. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .2204 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/29/2025 Number Present: 16 Completed Date: 10/29/2025 Age: From 0 To 4 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on twenty-three (23) violations cited during the annual compliance visit on 10/23/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. During the visit, the twenty-three (23) violations cited on 10/23/25 were monitored for compliance: Item #106 – A written plan has not been provided to state how fire inspections will be completed within 12 months of the previous inspection. We discussed that you plan have this on your reoccurring electronic calendar to contact the Fire Marshal prior to the inspection needing to be completed. A letter of compliance must be received on or before 11/6/25. Item #415 – This was corrected during the visit on 10/23/25. Item #428 – Current activity plans were not posted in space #1, #2A, and #2B. This is a repeat violation. Item #526 – The menu was not posted during the visit today. This is a repeat violation. Item #603 – You stated you have discussed the floor repairs needed with Clay County Department of Social Services (DSS), the owner of the building. We discussed you will also need to contact Clay County Environmental Health to determine how the exposed concrete on the floor can be repaired. A letter of compliance must be received on or before 11/6/25. Item #604 – The bathroom outside of space #1 was free of storage. This violation has been corrected and is in compliance. Item #721 – This was corrected during the visit on 10/23/25. Item #805 – A written plan has not been provided to state how fire drills will be practiced monthly. We discussed the person in charge, P.P., will be responsible for completing the monthly fire drill during your absence. A letter of compliance is due on or before 11/6/25. Item #840 – This item was corrected during the visit on 10/23/25. Item #858 – This item was corrected during the visit on 10/23/25. Item #859 – A written plan has not been provided to state how playground inspections will be completed monthly. We discussed the person in charge, P.P., will take playground safety training to complete the monthly playground inspections during your absence. A letter of compliance is due on or before 11/6/25. Item #887 – Sleep check documentation for 10/23/25 through today was reviewed during the visit. There was no sleep documentation completed for yesterday, 10/28/25. This is a repeat violation. Item #1030 – An application for employment for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the application is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1032 – A staff medical report for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the staff medical report is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1033 – A TB test/screening for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the TB test or TB screening is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1757 – A DCDEE Criminal Background Check (CBC) qualifying letter for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the DCDEE CBC qualifying letter is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1805 – Staff have not been assigned to the child care facility in the ABCMS portal. You provided the certificate of completion for the ABCMS training in the DCDEE Moodle. Staff will need to be assigned to the child care facility in the ABCMS portal. A letter of compliance is due on or before 11/6/25. Item #1795 – You thought there was an approved curriculum on-site; The Creative Curriculum® for Preschool, 4th Edition, Teaching Strategies, Inc., 2002. However, you stated that you will need to contact the owner to have the curriculum located, on-site, and implemented. The curriculum must be implemented with four year old children. The letter of compliance is due on or before 11/6/25. Item #1811 – A written statement has not been received as to how a shelter-in-place drill or lockdown drill will be completed every three months. We discussed the person in charge, P.P., will be responsible for completing the shelter-in-place drill or lockdown drill during your absence. A letter of compliance is due to be received on or before 11/6/25. Item #1831 – Upon arrival, the administrator was caring for the infants in space #2A, the classroom with infant and one year old children. At approximately 10:15am, staff M.A. arrived and began caring for the infants in space #2A. You stated that you and P.P. are scheduled to complete the ITS-SIDS training today at 6pm. C.W. is scheduled to complete the ITS-SIDS training on 11/10/25. The registration for the two (2) ITS-SIDS trainings scheduled for today at 6pm were verified during the visit. The staff M.A. has valid ITS-SIDS training. A letter of compliance is due on or before 11/6/25. Item #1874 – The signed acknowledgement for the prevention of shaken baby and abusive head trauma policy for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the prevention of shaken baby and abusive head trauma has been reviewed with the staff and the acknowledgement is on file. A letter of compliance is due on or before 11/6/25. Item #1897 – Staff member C.W. must complete Recognizing and Responding to Suspicions of Child Maltreatment training. This is an on-demand training that can be taken at any time, and can be located https://www.preventchildabusenc.org/online-trainings/. A letter of compliance is due on or before 11/6/25. Item #1898 – Staff members L.C., P.P., and C.W. must complete all required topics for the health and safety trainings. The DCDEE Moodle platform, https://www.dcdee.moodle.nc.gov/, offers the trainings for free and the trainings can be completed at any time since they are on-demand. A letter of compliance is due on or before 11/6/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; The children were observed in free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and eight (8) children ages two through four years. Space #2A – one (1) staff and two (2) infants and one (1) one year old child. Space #2B – one (1) staff and five (5) children ages one and two years. During the annual compliance visit, the following items were not monitored due to time constraints. These items were monitored during the visit today. *The First Aid Poster was hanging where it was not visible. The teacher in space #2B turned the poster around from the CPR side to the First Aid side. *The tobacco restriction was not posted at the entry of the facility. *Incident Log - The last entry date on the incident log was 7/10/24. In addition, the fire evacuation routes were reviewed during the visit today. 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 observed today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. This is a repeat violation from 10/23/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. This is a repeat violation from 10/23/25. 10A NCAC 09 .0901(b) 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Incident reports are being stored with the incident log and not in children’s files. .0802 (e) 853 Incident logs were not completed and maintained as required. The last incident report documented on incident log was dated 7/10/24. .0802(g)(1-6) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the infants in care yesterday, 10/28/25. This is a repeat violation from 10/23/25. .0606(g) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Based on the North Carolina Fire Inspection report, the following NC fire codes are not being met for space #2A, the classroom with infant and one year old children: #19 – Exits free of obstructions – a shelf is placed in front of the exit door; and #25 – All exits and their access (i.e. aisles and corridors) free of obstructions – the passageway outside of space #2A has discarded toys and equipment leaving the exit route partially blocked. GS 110-91 1850 Signage was not posted regarding the smoking and tobacco restriction at the entrance of the center and/or in vehicles used to transport children. A smoking and tobacco restriction poster was not posted at the entrance of the center. .0604(i) 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 • Signed statement of compliance I must receive your compliance statement on or before 11/12/25. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Achieving Compliance – rule references are noted in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, safe sleep checks will be documented while children twelve months old or younger are sleeping. It is recommended that you review this requirement with all staff working in the infant classroom. It is also recommended that you review the sleep charts periodically throughout the day to ensure they are completed. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Activity Plans – Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. It is recommended to have activity plans posted at the end of the day on Fridays for the next week. You completed the activity plans during the visit and posted them in their respective classrooms, spaces #1, #2A, and #2B. This was corrected during the visit. Menu Posted – Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. We also discussed that a two week rotating menu would help with identifying a shopping list and have the menus prepared for posting at all times. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. You posted the menu dated 10/27/25 through 10/31/25 during the visit. This was corrected during the visit. NC Fire Codes – Item #899 *To achieve compliance, the shelf in space #2A needs to be removed from the exit door area and storage needs to be cleared from the passageway leading from space #2A to the exterior of the building to allow for safe exiting of children in case of an emergency. You moved the shelf in space #2A to allow for access to the exit door to the outside. You also moved the toys and furniture to a place inaccessible to children that was blocking the exit pathway outdoors. This was corrected during the visit. Incident Reports – Item #852 *To achieve compliance, the incident reports stored with the incident logs must be filed in the respective children’s files. All future incident reports would be documented on the incident log and then filed in the child’s file. It is recommended to provide this task to a staff member during nap time to allow you to complete other administrative duties. Incident Log - Item #853 *To achieve compliance, the incident reports dated 10/31/24 through 9/22/25 must be documented on the incident log. You documented the incident reports from 10/31/24 through 9/22/25 on the incident log during the visit. This was corrected during the visit. It is recommended to have staff log the incident report and then you file the incident report in the child's file once reviewed. Smoking and Tobacco Restriction Poster - Item #1850 *We discussed you can find the smoking and tobacco restriction poster at the NC Health and Safety Resource Center online for an updated version. You posted the smoking and tobacco restriction poster on the parent board during the visit. This item was corrected during the visit. Consultation: Due to the number of violations, an administrative action may be recommended for the child care facility. Additional follow-up visits may be conducted. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed this with the county. It is recommended to implement staff training plans that help staff understand how many on-going training hours they need annually and what resources they have to take approved trainings. L.C. is required to have eight (8) ongoing training hours each year and is due to complete the 2024-2025 ongoing training hours on or before 12/1/25. P.P. is required to have ten (10) ongoing training hours each year and is due to complete the 2025-2026 ongoing training hours on or before 1/17/26. We discussed ideas for having staff complete trainings. This could be having staff coming in early, staying late, and/or completing during naptime if there is a substitute available that would allow for them to go to the office to complete required trainings. Ms. Owen followed up with the you regarding your thoughts on Quality Rating Improvement System (QRIS) and which pathway you would like to pursue for the star-rated license. You stated you would like to choose Pathway Two (2) Classroom and Instructional Quality. I explained that this pathway requires an approved curriculum across all age groups along with an approved formative assessment. You stated you understood and asked if you could use different approved curriculums among the age groups, yes. You were informed that you would need to complete both the facility and individual CQI. She acknowledged understanding. We also discussed the Assessment Outreach option, which could be beneficial for you and the program in completing the CQI. Additionally, we discussed that the QRIS application -Application for Assessment for a Rated License Centers with embedded links can be found on the DCDEE website, and that the NCRLAP link will be included with this information. It was discussed that you need to begin this process as soon as possible due to the timeframe for the implementation of this process. https://ncrlap.org/ Timeline for Rated License October- March determining which pathway is best for the facility and begin reviewing resources and begin self-study, CQI April- through September Submit Rated License application Resources: Southwestern Child Development Commission Child Care Resource and Referral - swcdcinc.org/ North Carolina Rated License Assessment Project (NCRLAP) – ncrlap.org North Carolina Health and Safety Resource Center – healthychildcare.unc.edu National Resource Center for Health and Safety in Child Care and Early Education – ncrkids.org Child Care Health Consultant, Mary Ramirez, Mary.ramirez@unc.edu or 828-338-8330 Ms. Owen reviewed the evacuation process with all staff present today. Each staff member was able to identify a primary and secondary exit, and one staff member provided a third option. I discussed and suggested to you, the importance of developing a posted evacuation route for each classroom that clearly defines both a primary and secondary exit. The four-star rated license dated 6/1/24 and temporary license dated 12/1/23 through 6/1/24 was collected and will be mailed to DCDEE in Raleigh. We discussed that you can request a technical assistance visit if you have specific child care rules you would like to review and understand better. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/29/2025 Number Present: 16 Completed Date: 10/29/2025 Age: From 0 To 4 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on twenty-three (23) violations cited during the annual compliance visit on 10/23/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. During the visit, the twenty-three (23) violations cited on 10/23/25 were monitored for compliance: Item #106 – A written plan has not been provided to state how fire inspections will be completed within 12 months of the previous inspection. We discussed that you plan have this on your reoccurring electronic calendar to contact the Fire Marshal prior to the inspection needing to be completed. A letter of compliance must be received on or before 11/6/25. Item #415 – This was corrected during the visit on 10/23/25. Item #428 – Current activity plans were not posted in space #1, #2A, and #2B. This is a repeat violation. Item #526 – The menu was not posted during the visit today. This is a repeat violation. Item #603 – You stated you have discussed the floor repairs needed with Clay County Department of Social Services (DSS), the owner of the building. We discussed you will also need to contact Clay County Environmental Health to determine how the exposed concrete on the floor can be repaired. A letter of compliance must be received on or before 11/6/25. Item #604 – The bathroom outside of space #1 was free of storage. This violation has been corrected and is in compliance. Item #721 – This was corrected during the visit on 10/23/25. Item #805 – A written plan has not been provided to state how fire drills will be practiced monthly. We discussed the person in charge, P.P., will be responsible for completing the monthly fire drill during your absence. A letter of compliance is due on or before 11/6/25. Item #840 – This item was corrected during the visit on 10/23/25. Item #858 – This item was corrected during the visit on 10/23/25. Item #859 – A written plan has not been provided to state how playground inspections will be completed monthly. We discussed the person in charge, P.P., will take playground safety training to complete the monthly playground inspections during your absence. A letter of compliance is due on or before 11/6/25. Item #887 – Sleep check documentation for 10/23/25 through today was reviewed during the visit. There was no sleep documentation completed for yesterday, 10/28/25. This is a repeat violation. Item #1030 – An application for employment for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the application is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1032 – A staff medical report for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the staff medical report is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1033 – A TB test/screening for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the TB test or TB screening is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1757 – A DCDEE Criminal Background Check (CBC) qualifying letter for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the DCDEE CBC qualifying letter is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1805 – Staff have not been assigned to the child care facility in the ABCMS portal. You provided the certificate of completion for the ABCMS training in the DCDEE Moodle. Staff will need to be assigned to the child care facility in the ABCMS portal. A letter of compliance is due on or before 11/6/25. Item #1795 – You thought there was an approved curriculum on-site; The Creative Curriculum® for Preschool, 4th Edition, Teaching Strategies, Inc., 2002. However, you stated that you will need to contact the owner to have the curriculum located, on-site, and implemented. The curriculum must be implemented with four year old children. The letter of compliance is due on or before 11/6/25. Item #1811 – A written statement has not been received as to how a shelter-in-place drill or lockdown drill will be completed every three months. We discussed the person in charge, P.P., will be responsible for completing the shelter-in-place drill or lockdown drill during your absence. A letter of compliance is due to be received on or before 11/6/25. Item #1831 – Upon arrival, the administrator was caring for the infants in space #2A, the classroom with infant and one year old children. At approximately 10:15am, staff M.A. arrived and began caring for the infants in space #2A. You stated that you and P.P. are scheduled to complete the ITS-SIDS training today at 6pm. C.W. is scheduled to complete the ITS-SIDS training on 11/10/25. The registration for the two (2) ITS-SIDS trainings scheduled for today at 6pm were verified during the visit. The staff M.A. has valid ITS-SIDS training. A letter of compliance is due on or before 11/6/25. Item #1874 – The signed acknowledgement for the prevention of shaken baby and abusive head trauma policy for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the prevention of shaken baby and abusive head trauma has been reviewed with the staff and the acknowledgement is on file. A letter of compliance is due on or before 11/6/25. Item #1897 – Staff member C.W. must complete Recognizing and Responding to Suspicions of Child Maltreatment training. This is an on-demand training that can be taken at any time, and can be located https://www.preventchildabusenc.org/online-trainings/. A letter of compliance is due on or before 11/6/25. Item #1898 – Staff members L.C., P.P., and C.W. must complete all required topics for the health and safety trainings. The DCDEE Moodle platform, https://www.dcdee.moodle.nc.gov/, offers the trainings for free and the trainings can be completed at any time since they are on-demand. A letter of compliance is due on or before 11/6/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; The children were observed in free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and eight (8) children ages two through four years. Space #2A – one (1) staff and two (2) infants and one (1) one year old child. Space #2B – one (1) staff and five (5) children ages one and two years. During the annual compliance visit, the following items were not monitored due to time constraints. These items were monitored during the visit today. *The First Aid Poster was hanging where it was not visible. The teacher in space #2B turned the poster around from the CPR side to the First Aid side. *The tobacco restriction was not posted at the entry of the facility. *Incident Log - The last entry date on the incident log was 7/10/24. In addition, the fire evacuation routes were reviewed during the visit today. 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 observed today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. This is a repeat violation from 10/23/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. This is a repeat violation from 10/23/25. 10A NCAC 09 .0901(b) 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Incident reports are being stored with the incident log and not in children’s files. .0802 (e) 853 Incident logs were not completed and maintained as required. The last incident report documented on incident log was dated 7/10/24. .0802(g)(1-6) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the infants in care yesterday, 10/28/25. This is a repeat violation from 10/23/25. .0606(g) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Based on the North Carolina Fire Inspection report, the following NC fire codes are not being met for space #2A, the classroom with infant and one year old children: #19 – Exits free of obstructions – a shelf is placed in front of the exit door; and #25 – All exits and their access (i.e. aisles and corridors) free of obstructions – the passageway outside of space #2A has discarded toys and equipment leaving the exit route partially blocked. GS 110-91 1850 Signage was not posted regarding the smoking and tobacco restriction at the entrance of the center and/or in vehicles used to transport children. A smoking and tobacco restriction poster was not posted at the entrance of the center. .0604(i) 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 • Signed statement of compliance I must receive your compliance statement on or before 11/12/25. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Achieving Compliance – rule references are noted in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, safe sleep checks will be documented while children twelve months old or younger are sleeping. It is recommended that you review this requirement with all staff working in the infant classroom. It is also recommended that you review the sleep charts periodically throughout the day to ensure they are completed. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Activity Plans – Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. It is recommended to have activity plans posted at the end of the day on Fridays for the next week. You completed the activity plans during the visit and posted them in their respective classrooms, spaces #1, #2A, and #2B. This was corrected during the visit. Menu Posted – Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. We also discussed that a two week rotating menu would help with identifying a shopping list and have the menus prepared for posting at all times. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. You posted the menu dated 10/27/25 through 10/31/25 during the visit. This was corrected during the visit. NC Fire Codes – Item #899 *To achieve compliance, the shelf in space #2A needs to be removed from the exit door area and storage needs to be cleared from the passageway leading from space #2A to the exterior of the building to allow for safe exiting of children in case of an emergency. You moved the shelf in space #2A to allow for access to the exit door to the outside. You also moved the toys and furniture to a place inaccessible to children that was blocking the exit pathway outdoors. This was corrected during the visit. Incident Reports – Item #852 *To achieve compliance, the incident reports stored with the incident logs must be filed in the respective children’s files. All future incident reports would be documented on the incident log and then filed in the child’s file. It is recommended to provide this task to a staff member during nap time to allow you to complete other administrative duties. Incident Log - Item #853 *To achieve compliance, the incident reports dated 10/31/24 through 9/22/25 must be documented on the incident log. You documented the incident reports from 10/31/24 through 9/22/25 on the incident log during the visit. This was corrected during the visit. It is recommended to have staff log the incident report and then you file the incident report in the child's file once reviewed. Smoking and Tobacco Restriction Poster - Item #1850 *We discussed you can find the smoking and tobacco restriction poster at the NC Health and Safety Resource Center online for an updated version. You posted the smoking and tobacco restriction poster on the parent board during the visit. This item was corrected during the visit. Consultation: Due to the number of violations, an administrative action may be recommended for the child care facility. Additional follow-up visits may be conducted. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed this with the county. It is recommended to implement staff training plans that help staff understand how many on-going training hours they need annually and what resources they have to take approved trainings. L.C. is required to have eight (8) ongoing training hours each year and is due to complete the 2024-2025 ongoing training hours on or before 12/1/25. P.P. is required to have ten (10) ongoing training hours each year and is due to complete the 2025-2026 ongoing training hours on or before 1/17/26. We discussed ideas for having staff complete trainings. This could be having staff coming in early, staying late, and/or completing during naptime if there is a substitute available that would allow for them to go to the office to complete required trainings. Ms. Owen followed up with the you regarding your thoughts on Quality Rating Improvement System (QRIS) and which pathway you would like to pursue for the star-rated license. You stated you would like to choose Pathway Two (2) Classroom and Instructional Quality. I explained that this pathway requires an approved curriculum across all age groups along with an approved formative assessment. You stated you understood and asked if you could use different approved curriculums among the age groups, yes. You were informed that you would need to complete both the facility and individual CQI. She acknowledged understanding. We also discussed the Assessment Outreach option, which could be beneficial for you and the program in completing the CQI. Additionally, we discussed that the QRIS application -Application for Assessment for a Rated License Centers with embedded links can be found on the DCDEE website, and that the NCRLAP link will be included with this information. It was discussed that you need to begin this process as soon as possible due to the timeframe for the implementation of this process. https://ncrlap.org/ Timeline for Rated License October- March determining which pathway is best for the facility and begin reviewing resources and begin self-study, CQI April- through September Submit Rated License application Resources: Southwestern Child Development Commission Child Care Resource and Referral - swcdcinc.org/ North Carolina Rated License Assessment Project (NCRLAP) – ncrlap.org North Carolina Health and Safety Resource Center – healthychildcare.unc.edu National Resource Center for Health and Safety in Child Care and Early Education – ncrkids.org Child Care Health Consultant, Mary Ramirez, Mary.ramirez@unc.edu or 828-338-8330 Ms. Owen reviewed the evacuation process with all staff present today. Each staff member was able to identify a primary and secondary exit, and one staff member provided a third option. I discussed and suggested to you, the importance of developing a posted evacuation route for each classroom that clearly defines both a primary and secondary exit. The four-star rated license dated 6/1/24 and temporary license dated 12/1/23 through 6/1/24 was collected and will be mailed to DCDEE in Raleigh. We discussed that you can request a technical assistance visit if you have specific child care rules you would like to review and understand better. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
GS 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/29/2025 Number Present: 16 Completed Date: 10/29/2025 Age: From 0 To 4 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Compliance Follow-Up Announced/Unannounced: Unannounced The purpose of the unannounced visit today was to follow-up on twenty-three (23) violations cited during the annual compliance visit on 10/23/25. Bridget Owen, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on-site and available to answer and ask questions. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. The following was monitored during the visit: Including, but not limited to, supervision, staff/child ratio, adequate approved space, and permit restrictions. During the visit, the twenty-three (23) violations cited on 10/23/25 were monitored for compliance: Item #106 – A written plan has not been provided to state how fire inspections will be completed within 12 months of the previous inspection. We discussed that you plan have this on your reoccurring electronic calendar to contact the Fire Marshal prior to the inspection needing to be completed. A letter of compliance must be received on or before 11/6/25. Item #415 – This was corrected during the visit on 10/23/25. Item #428 – Current activity plans were not posted in space #1, #2A, and #2B. This is a repeat violation. Item #526 – The menu was not posted during the visit today. This is a repeat violation. Item #603 – You stated you have discussed the floor repairs needed with Clay County Department of Social Services (DSS), the owner of the building. We discussed you will also need to contact Clay County Environmental Health to determine how the exposed concrete on the floor can be repaired. A letter of compliance must be received on or before 11/6/25. Item #604 – The bathroom outside of space #1 was free of storage. This violation has been corrected and is in compliance. Item #721 – This was corrected during the visit on 10/23/25. Item #805 – A written plan has not been provided to state how fire drills will be practiced monthly. We discussed the person in charge, P.P., will be responsible for completing the monthly fire drill during your absence. A letter of compliance is due on or before 11/6/25. Item #840 – This item was corrected during the visit on 10/23/25. Item #858 – This item was corrected during the visit on 10/23/25. Item #859 – A written plan has not been provided to state how playground inspections will be completed monthly. We discussed the person in charge, P.P., will take playground safety training to complete the monthly playground inspections during your absence. A letter of compliance is due on or before 11/6/25. Item #887 – Sleep check documentation for 10/23/25 through today was reviewed during the visit. There was no sleep documentation completed for yesterday, 10/28/25. This is a repeat violation. Item #1030 – An application for employment for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the application is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1032 – A staff medical report for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the staff medical report is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1033 – A TB test/screening for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the TB test or TB screening is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1757 – A DCDEE Criminal Background Check (CBC) qualifying letter for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the DCDEE CBC qualifying letter is completed and on file. A letter of compliance is due on or before 11/6/25. Item #1805 – Staff have not been assigned to the child care facility in the ABCMS portal. You provided the certificate of completion for the ABCMS training in the DCDEE Moodle. Staff will need to be assigned to the child care facility in the ABCMS portal. A letter of compliance is due on or before 11/6/25. Item #1795 – You thought there was an approved curriculum on-site; The Creative Curriculum® for Preschool, 4th Edition, Teaching Strategies, Inc., 2002. However, you stated that you will need to contact the owner to have the curriculum located, on-site, and implemented. The curriculum must be implemented with four year old children. The letter of compliance is due on or before 11/6/25. Item #1811 – A written statement has not been received as to how a shelter-in-place drill or lockdown drill will be completed every three months. We discussed the person in charge, P.P., will be responsible for completing the shelter-in-place drill or lockdown drill during your absence. A letter of compliance is due to be received on or before 11/6/25. Item #1831 – Upon arrival, the administrator was caring for the infants in space #2A, the classroom with infant and one year old children. At approximately 10:15am, staff M.A. arrived and began caring for the infants in space #2A. You stated that you and P.P. are scheduled to complete the ITS-SIDS training today at 6pm. C.W. is scheduled to complete the ITS-SIDS training on 11/10/25. The registration for the two (2) ITS-SIDS trainings scheduled for today at 6pm were verified during the visit. The staff M.A. has valid ITS-SIDS training. A letter of compliance is due on or before 11/6/25. Item #1874 – The signed acknowledgement for the prevention of shaken baby and abusive head trauma policy for the staff hired on 10/21/25 was not verified to be on file during the visit today. You stated the staff KHM has not returned to work and will not be allowed to return to work until the prevention of shaken baby and abusive head trauma has been reviewed with the staff and the acknowledgement is on file. A letter of compliance is due on or before 11/6/25. Item #1897 – Staff member C.W. must complete Recognizing and Responding to Suspicions of Child Maltreatment training. This is an on-demand training that can be taken at any time, and can be located https://www.preventchildabusenc.org/online-trainings/. A letter of compliance is due on or before 11/6/25. Item #1898 – Staff members L.C., P.P., and C.W. must complete all required topics for the health and safety trainings. The DCDEE Moodle platform, https://www.dcdee.moodle.nc.gov/, offers the trainings for free and the trainings can be completed at any time since they are on-demand. A letter of compliance is due on or before 11/6/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; The children were observed in free play and routine care. Staff/child ratios were as follows: Space #1 – one (1) staff and eight (8) children ages two through four years. Space #2A – one (1) staff and two (2) infants and one (1) one year old child. Space #2B – one (1) staff and five (5) children ages one and two years. During the annual compliance visit, the following items were not monitored due to time constraints. These items were monitored during the visit today. *The First Aid Poster was hanging where it was not visible. The teacher in space #2B turned the poster around from the CPR side to the First Aid side. *The tobacco restriction was not posted at the entry of the facility. *Incident Log - The last entry date on the incident log was 7/10/24. In addition, the fire evacuation routes were reviewed during the visit today. 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 observed today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. This is a repeat violation from 10/23/25. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for this week was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. This is a repeat violation from 10/23/25. 10A NCAC 09 .0901(b) 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. Incident reports are being stored with the incident log and not in children’s files. .0802 (e) 853 Incident logs were not completed and maintained as required. The last incident report documented on incident log was dated 7/10/24. .0802(g)(1-6) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the infants in care yesterday, 10/28/25. This is a repeat violation from 10/23/25. .0606(g) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Based on the North Carolina Fire Inspection report, the following NC fire codes are not being met for space #2A, the classroom with infant and one year old children: #19 – Exits free of obstructions – a shelf is placed in front of the exit door; and #25 – All exits and their access (i.e. aisles and corridors) free of obstructions – the passageway outside of space #2A has discarded toys and equipment leaving the exit route partially blocked. GS 110-91 1850 Signage was not posted regarding the smoking and tobacco restriction at the entrance of the center and/or in vehicles used to transport children. A smoking and tobacco restriction poster was not posted at the entrance of the center. .0604(i) 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 • Signed statement of compliance I must receive your compliance statement on or before 11/12/25. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck 151 Creekview Rd, Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Achieving Compliance – rule references are noted in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, safe sleep checks will be documented while children twelve months old or younger are sleeping. It is recommended that you review this requirement with all staff working in the infant classroom. It is also recommended that you review the sleep charts periodically throughout the day to ensure they are completed. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. Activity Plans – Item #428 *To achieve compliance, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Current activity plans allow staff to have a guide of what activities are to be implemented each day and throughout the week. It also helps any substitute staff know what activities are planned to implement the documented activities with children in the absence of the lead teacher. It is recommended to have activity plans posted at the end of the day on Fridays for the next week. You completed the activity plans during the visit and posted them in their respective classrooms, spaces #1, #2A, and #2B. This was corrected during the visit. Menu Posted – Item #526 *To achieve compliance, the menu for the current week must be posted. We discussed a plan must also be created to state how menus will be posted for the current week. It is recommended to post menus for the next week at the end of the day on Fridays. We also discussed that a two week rotating menu would help with identifying a shopping list and have the menus prepared for posting at all times. A current menu allows parents to know what their child will be offered during care. Any substitutions that are made must be written on the menu prior to serving the food to children. If a child had a reaction to a certain food, the menu would help identify the potential source. You posted the menu dated 10/27/25 through 10/31/25 during the visit. This was corrected during the visit. NC Fire Codes – Item #899 *To achieve compliance, the shelf in space #2A needs to be removed from the exit door area and storage needs to be cleared from the passageway leading from space #2A to the exterior of the building to allow for safe exiting of children in case of an emergency. You moved the shelf in space #2A to allow for access to the exit door to the outside. You also moved the toys and furniture to a place inaccessible to children that was blocking the exit pathway outdoors. This was corrected during the visit. Incident Reports – Item #852 *To achieve compliance, the incident reports stored with the incident logs must be filed in the respective children’s files. All future incident reports would be documented on the incident log and then filed in the child’s file. It is recommended to provide this task to a staff member during nap time to allow you to complete other administrative duties. Incident Log - Item #853 *To achieve compliance, the incident reports dated 10/31/24 through 9/22/25 must be documented on the incident log. You documented the incident reports from 10/31/24 through 9/22/25 on the incident log during the visit. This was corrected during the visit. It is recommended to have staff log the incident report and then you file the incident report in the child's file once reviewed. Smoking and Tobacco Restriction Poster - Item #1850 *We discussed you can find the smoking and tobacco restriction poster at the NC Health and Safety Resource Center online for an updated version. You posted the smoking and tobacco restriction poster on the parent board during the visit. This item was corrected during the visit. Consultation: Due to the number of violations, an administrative action may be recommended for the child care facility. Additional follow-up visits may be conducted. There are broken windows that have been temporarily repaired with a cereal box and white duct tape. You stated the long term plan to have the windows repaired and have discussed this with the county. It is recommended to implement staff training plans that help staff understand how many on-going training hours they need annually and what resources they have to take approved trainings. L.C. is required to have eight (8) ongoing training hours each year and is due to complete the 2024-2025 ongoing training hours on or before 12/1/25. P.P. is required to have ten (10) ongoing training hours each year and is due to complete the 2025-2026 ongoing training hours on or before 1/17/26. We discussed ideas for having staff complete trainings. This could be having staff coming in early, staying late, and/or completing during naptime if there is a substitute available that would allow for them to go to the office to complete required trainings. Ms. Owen followed up with the you regarding your thoughts on Quality Rating Improvement System (QRIS) and which pathway you would like to pursue for the star-rated license. You stated you would like to choose Pathway Two (2) Classroom and Instructional Quality. I explained that this pathway requires an approved curriculum across all age groups along with an approved formative assessment. You stated you understood and asked if you could use different approved curriculums among the age groups, yes. You were informed that you would need to complete both the facility and individual CQI. She acknowledged understanding. We also discussed the Assessment Outreach option, which could be beneficial for you and the program in completing the CQI. Additionally, we discussed that the QRIS application -Application for Assessment for a Rated License Centers with embedded links can be found on the DCDEE website, and that the NCRLAP link will be included with this information. It was discussed that you need to begin this process as soon as possible due to the timeframe for the implementation of this process. https://ncrlap.org/ Timeline for Rated License October- March determining which pathway is best for the facility and begin reviewing resources and begin self-study, CQI April- through September Submit Rated License application Resources: Southwestern Child Development Commission Child Care Resource and Referral - swcdcinc.org/ North Carolina Rated License Assessment Project (NCRLAP) – ncrlap.org North Carolina Health and Safety Resource Center – healthychildcare.unc.edu National Resource Center for Health and Safety in Child Care and Early Education – ncrkids.org Child Care Health Consultant, Mary Ramirez, Mary.ramirez@unc.edu or 828-338-8330 Ms. Owen reviewed the evacuation process with all staff present today. Each staff member was able to identify a primary and secondary exit, and one staff member provided a third option. I discussed and suggested to you, the importance of developing a posted evacuation route for each classroom that clearly defines both a primary and secondary exit. The four-star rated license dated 6/1/24 and temporary license dated 12/1/23 through 6/1/24 was collected and will be mailed to DCDEE in Raleigh. We discussed that you can request a technical assistance visit if you have specific child care rules you would like to review and understand better. A computerized generated report of today’s visit was completed, signed, and an electronic copy of the visit summary was left on-site. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0304 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0514 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0604 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0606 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0701 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0901 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .1102 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .1703 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .1801 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2204 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .3222 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
GS 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
NC GS 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 10/23/2025 Number Present: 18 Completed Date: 10/23/2025 Age: From 0 To 4 Total Minutes: 445 Time In: 10:05 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during an annual compliance visit. Bridget Owen, Child Care Consultant, accompanied me on the visit. A computerized generated report of today’s visit was completed, reviewed with you, a signed copy of the visit summary was left on-site for you. Upon arrival, the Special Provisional License, cover letter, and corrective action plan were posted at the entry where it could be viewed by parents and visitors. Lily Coffey, Administrator, was on-site and available to answer and ask questions. 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 percent (90%) percent as of 10/22/25. The ownership of the child care facility is Tiny Toes Learning Center Hayesville LLC, which is listed as active-not current on the North Carolina Secretary of State (NCSOS) website as of today. The last annual filing was completed on 7/14/24. A notice of annual report, notice of grounds, was sent to Kaitlyn Frady on 9/12/25 from NCSOS. The notice explained that failing to file all delinquent reports within sixty (60) days of the notice will result in the business entity being administratively dissolved/revoked. If the facility is not in good standing with the NCSOS, an administrative action may be issued. 10A NCAC 09 .2204 PROVISIONAL CHILD CARE FACILITY LICENSE OR PROVISIONAL NOTICE OF COMPLIANCE (4) to allow a time period for correction of an administratively dissolved corporation status from the North Carolina Secretary of State; Permit type – Special Provisional License dated 6/30/25, capacity of twenty-nine (29) children ages 0-5 years. Special Services/Restrictions – Approved for daytime care only, meets enhanced space, meets enhanced staff/child ratios. The last fire drill was practiced on 10/9/25. The last shelter-in-place drill was practiced on 9/30/25. The last fire inspection was completed on 10/14/25. The last sanitation inspection was conducted on 9/9/25 with seventeen (17) demerits for a Approved classification. The Emergency Medical Care plan was current. Lead water testing was completed on 11/15/24. The lead based paint survey has been completed and is under review by RTI. The asbestos survey has not been completed. The administrator has updated the facility’s Emergency Preparedness and Response Plan, effective October 1, 2025. However, the floor plan is missing from the updated plan. The children were observed during free play, routine care, lunch, and rest time. The lunch today was ham, cheese, crackers, broccoli, applesauce, and milk. A menu was not posted. During observation of indoor space #1, the classroom with three and four year old children, the children were engaged in free play. The teacher was interacting with children and asking questions about the materials they were exploring. During observation of indoor space #2A, the classroom with infants, one infant was asleep with their back on a pillow on the floor when we walked in the classroom room. The teacher was holding another infant that was fussy. Once the child being held was placed in a bouncy seat, the sleeping infant was placed in a crib to sleep. The other infants were exploring the classroom and playing with toys. During observations of indoor space #2B, the classroom for one and two year old children, the children were playing with materials in the classroom. The teacher was sitting in a chair observing the children as they played. The teacher was up and moving around the classroom to assist in finding a posted schedule and during lunch. During the observations of outdoor space #1, several toys were noted to be broken or in disrepair. Items observed not in good repair included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. Additionally, the door leading from the outside play area into Space 1 was observed to be in need repair due to chipping paint. A Spiderman figure was also observed on the roof of the building. The sandbox was observed to be uncovered at the time of the observation. During the observation of outdoor pace #2, all toys and materials were observed piled together in one section of the playground rather than arranged for active play. The bouncy seat and stationary activity seat were noted to have visible mold and were not in good repair, as well as trikes and a basketball hoop that were observed to have rust. Additionally, a mop bucket was observed outside the door leading to outdoor space #2. Ms. Coffey stated this playground has not been used recently and all children are playing on outdoor space #1. The staff and training worksheet was not completed upon arrival. Ms. Coffey completed the staff and training worksheet during the visit for four (4) staff. There are six (6) staff and one (1) legal operator. Due to the staff and training worksheets missing information, four (4) existing staff files were monitored, and two (2) new staff files were monitored. There are twenty-three (23) children enrolled, and two (2) children’s files were monitored. The Child Care Center Item Number Listing (DCDEE-0357) was used as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on 10/14/25. The previous fire inspection was conducted on 11/27/23. 10A NCAC 09 .0304(a) 415 A current schedule was not posted for each group of children for reference. A schedule was not posted in space #2B, the classroom for one and two year old children. GS 110-91(12);.0508(a) 428 A current activity plan was not posted for each group of children for reference. Classroom spaces #1, #2A, and #2B did not have current activity plans posted. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu was not posted in the kitchen where it could be seen by food preparation staff or in an area where it could be seen by parents. 10A NCAC 09 .0901(b) 603 All floors and floor coverings were not constructed of nonabsorbent material and/or were not kept clean and in good repair. During the sanitation inspection on 9/9/25, item #37 was cited as a four (4) point demerit and cited that floor tiles need to be repaired through where cracked. During the walk through observation in space #1, the classroom with three and four year old children, there were multiple areas where the floor was cracked and concrete exposed, including the bathroom floor in space #1. 15A NCAC 18A .2824(a)&(b) 604 Lavatories were not kept clean, in good repair and kept free of storage. During the sanitation inspection on 9/9/25, item #23 was cited as a two (2) point demerit and cited that storage in bathrooms that do not pertain to toileting or diapering shall be removed from bathrooms (table, storage bins, clothing removed, etc.). During the walk through observation, one of the two bathrooms in space #1, the classroom with three and four year old children, had storage of bins, equipment, and materials. 15A NCAC 18A .2818(a) 721 All equipment and furnishings were not in good repair. There were materials and equipment that were not in good repair on outdoor space #1 that included, but were not limited to, a pink Cozy Coupe, an exersaucer, a play truck (appearing to be a dump truck missing the back and cab), a green truck, and two (2) riding toys. There were also materials and equipment that were not in good repair on outdoor space #2 that included, but were not limited to, a bouncy seat and stationary activity seat noted to have visible mold, as well as trikes and a basketball hoop that were observed to have rust. G.S. 110-91(6); .0601(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. A fire drill for December 2024 was not documented as being practiced. .0604(t); .0302(d)(5) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. During the observation, it was noted that the door leading from space #1, the classroom with three and four year old children, to the kitchen was unlocked, with a key left in the door. Hazardous materials, including Lysol multipurpose cleaner and Great Value glass cleaner, were stored in the kitchen in an unlocked cabinet under five feet and were accessible. The glass cleaner had “Keep Out of Reach of Children” warning and the Lysol multi-purpose cleaner had multiple warnings. .2820(b) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. During the observation in space #2B, the classroom with infant and one year old children, plastic bags and plastic wrapping from items such as wipes, toilet paper, and paper towels were stored below five feet and were within reach of children under three years of age. On outdoor space #1, the playground for infants through five year old children, there was a plastic bag for trash hanging below five feet and accessible to children under three years of age. .0604(q) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2024. .0605(q) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. There was no documentation of safe sleep checks for the four (4) enrolled infants for the last month. .0606(g) 1030 Application for employment and date of birth was not on file for all staff. An application for employment and date of birth was not on file for all staff. One (1) staff hired on 10/21/25, did not have an application for employment or verification of date of birth on file. .0302(d)(1)(A) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a staff medical report. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One (1) staff member, that was reported to have begun employment on 10/21/25, did not have documentation of completing a TB test or TB screening. .0701(a) 1757 A valid qualification letter was not on file and available to review at the facility. A DCDEE Criminal Background Check (CBC) qualifying letter was not on file for one (1) staff member prior to employment that was reported to have started employment on 10/21/25 and there was not a CBC qualifying letter on file at the facility. G.S. 110-90.2(b) & (d) & .2703(e) 1794 A Four- or Five- Star program serving four year old children was not implementing an approved curriculum. During discussion, the administrator stated that a curriculum was not being used with four year old children. .2802(d) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. The child care operator has not notified the Division of any of the six (6) staff that are hired at the child care facility, as well as the legal operator. G.S. 110-90.2 & .2703(r) 1811 Shelter-in-place or lockdown drills were not practiced every three months and/or drill record was incomplete. A shelter-in-place drill was practiced on 9/19/24. The next shelter-in-place was practiced on 3/12/25. A required drill was not practiced every three months. .0604(u);.0302(d)(8) 1831 At least one child care provider, who has completed ITS-SIDS training was not present in the infant room, while children were in care. Of the four (4) staff on-site during the visit today, there were no staff that had valid ITS-SIDS training on file. There were four (4) infants being cared for in space #2A, the classroom for infants and one year old children. The administrator had her ITS-SIDS training expire on 5/11/25. One (1) staff hired on 1/17/24 and caring for infants upon arrival to the center had her ITS-SIDS training expire on 10/6/25. One (1) staff hired on 10/9/24 and caring for infants during the visit had her ITS-SIDS training expire on 6/11/25. One (1) staff hired yesterday, 10/22/25, has not taken the ITS-SIDS training yet. .01102 (f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. One (1) staff member was reported to have begun employment on 10/21/25, cared for children in a classroom, and did not have the acknowledgement form for the policy on file to verify the policy had been reviewed with the staff member. .0608(d)(1-4) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. One (1) staff hired on 10/9/24 does not have documentation on file for completing Recognizing and Responding to Suspicions of Child Maltreatment training. .1102(g) 1898 Staff did not complete the health and safety training within one year of employment. The administrator began employment on 12/1/23 and has not completed all required health and safety training topics. One (1) staff hired on 1/17/24 has not completed the required health safety training topics. One (1) staff hired on 10/9/24 has not completed the required health and safety training topics. .1102(a) 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 11/6/25. Email the compliance letter on signed letterhead or in the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck 151 Creekview Rd Hendersonville, NC 28792 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt 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. Technical Assistance for Compliance – rule references can be found in the cited violations Documented Sleep Checks – Item #887 *To achieve compliance, a plan must be created to state how safe sleep checks will be documented. During the visit today, the safe sleep check documentation was started on the four (4) infants in attendance. To ensure the safety of the infants in care, it is important to check on infants while they are sleeping and ensure the infant is breathing and that they have a normal skin color, not pale, blue, or discolored. ITS-SIDS Training – Item #1831 *To achieve compliance, there must be a staff person in the room caring for infants that has valid ITS-SIDS training, staff must complete ITS-SIDS training to be left alone in the classroom caring for infants. A plan will also need to be created to state how you will track when staff are due for their three year renewal of the training. There is one (1) substitute that was not on-site today that has valid ITS-SIDS training that does not expire until 9/12/26. However, Ms. Coffey explained that this staff member does not substitute very often. You stated you will plan to contact the substitute and see what schedule she is available to work. We discussed the importance of the ITS-SIDS training is to understand how to keep infants safe in the in their environment while they sleep. Storage of Chemicals – Item #840 *All hazardous materials must be stored out of reach of children and in locked cabinets. The kitchen door must remain locked when not in use and all cleaning supplies be secured in a locked cabinet or storage area inaccessible to children to prevent accidental exposure. It is recommended to review the sanitation requirement with staff. The kitchen door was locked during the visit, and the key stored at least five feet above the floor. This was corrected during the visit. Plastic Bags Accessible to Children Under Three Years of Age – Item #858 *Per North Carolina Child Care Licensing Rule 10A NCAC 09 .0604(q) – Safety Precautions, materials that pose a choking or suffocation hazard must be kept out of reach of children under three years old. It is recommended that all plastic bags and wrapping be stored in a secure location above the reach of young children to prevent accidental injury or suffocation. It is recommended to have a trash can with a lid outdoors that allows for trash disposal when children are playing outdoors. It is recommended to review this requirement with staff. All plastic bags were moved to five feet or above, or discarded. This was corrected during the visit. Materials and Equipment in Good Repair – Item #721 *The materials and equipment were moved off outdoor spaces #1 and #2 to an area not used by children to make these items inaccessible to children. This was corrected during the visit. DCDEE Criminal Background Check (CBC) – Items #1757 and #1805 *To achieve compliance, Kendra Hensley-Moss must have her DCDEE CBC qualifying letter that was located on the ABCMS portal on file at the facility and a plan must be put in place to state how future new staff will have the letter on file prior to employment. Having a CBC qualifying letter on file prior to employment is for the safety of the children to ensure the person being hired is qualified for child care employment. **New and terminated staff notification requirement: As stated in G.S. 110-90.2 & .2703(r) child care operators are to notify the Division of any new child care providers working who were hired or moved into the child care facility within five business days. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-6401 and someone will assist you. Fire Inspection – Item #106 *To achieve compliance, a plan must be created to state how fire inspections will be scheduled within (twelve) 12 months of the last fire inspection. We discussed that annual fire inspections are completed for the safety of the children and ensure the child care facility is meeting North Carolina Fire Codes. We further discussed that it is your responsibility to contact the fire inspector. Fire Drills and Shelter-in-Place Drills/Lockdown Drills– Items #805 and #1811 *To achieve compliance for fire drills, a plan must be created to state how fire drills will be practiced monthly. To achieve compliance for shelter-in-place drills and lockdown drills, a plan must be put in place to state how the emergency drills will be practiced every three (3) months. Review the plan with staff. It is important to practice these drills when required to allow for children to understand the route for evacuation and evacuate safety, as well as understand where to go for the shelter-in-place or lockdown. Monthly Playground Inspections – Item #859 *To achieve compliance, a plan must be put in place to state how playground inspections will occur each month. It is important to complete the monthly playground inspection to remove safety hazards for children and create a safe outdoor learning environment. Staff Medical Report – Item #1032 *To achieve compliance, KHM must have staff medical report completed by a health care professional. Also, a plan must be created to state how new staff will have the staff medical report completed prior to employment. We discussed that new staff must have verification from a health care professional that they are physical and emotionally fit to care for children to create a safe and healthy environment. TB Test/Screening – Item #1033 *To achieve compliance, the staff must have a TB test or TB screening completed by a health care professional. Also, a plan must be created to state how new staff will have the TB test or TB screening completed by day one of employment. We discussed that new staff must have verification of being free from Tuberculosis before working with children to create a safe and healthy environment. Prevention of Shaken Baby and Abusive Head Trauma Policy – Item #1874 *To achieve compliance, the policy must be reviewed with the staff, the staff must sign the acknowledgment for the policy, and a plan must be created to state how new staff will review the policy prior to caring for children. We discussed that new staff need to understand what prevention methods there are, as well as signs of shaken baby syndrome and abusive head trauma. In addition, new staff need to know what resources are available to them and how the policy is implemented in the program. Recognizing and Responding to Suspicions of Child Maltreatment Training - Item #1897 *To achieve compliance, C.W. must successfully complete Recognizing and Responding to Suspicions of Child Maltreatment training and the training certificate must be on file at the child care facility. A plan must also be created to state how new staff will have the training completed within ninety (90) days of employment as required. It would be recommended to have staff take the training within the first two weeks of their employment. The training is important in helping staff recognize any signs of child maltreatment. Health and Safety Training – Item #1898 *To achieve compliance, the three (3) staff L.C., P.P., and C.W. must complete all required health and safety trainings in the required topic areas. These training can be located on the DCDEE Moodle platform and are on-demand to be taken at any time. It is recommended to have new staff complete the health and safety training within their six (6) week orientation training or have a plan of how staff will complete the required health and safety trainings within their first twelve (12) months of employment. Reminder that health and safety trainings cannot be used as new staff orientation hours. Floors in Poor Repair – Item #603 *To achieve compliance, the floor cracks must be repaired according to the sanitation rule below. Concrete is an absorbent surface and the floor cracks would need to be repaired back to a nonabsorbent material. Clay County owns the building. You stated that you would be talking with a representative from Clay County on 10/24/25 to discuss the issue. It is recommended to contact Clay County Environmental Health for ideas and suggestions on how to repair the floor. 15A NCAC 18A .2824 FLOORS (a) In child care centers, floors and floor coverings in food preparation, food storage, utensil washing, toilet rooms, and laundry areas shall be constructed of nonabsorbent material and shall be kept clean and in good repair. (b) Floors and floor coverings in sleeping and play areas shall be kept clean and in good repair. Bathroom Storage – Item #604 *To achieve compliance, all storage in the bathrooms not pertaining to toileting or diapering must be removed. Some items were removed during the visit. 15A NCAC 18A .2818 LAVATORIES (a) In child care centers, lavatories shall be kept clean and in good repair and shall not be used for storage. Lavatories shall be mounted at an appropriate height to accommodate children or otherwise made accessible to children. Water from a handwash lavatory shall not be used for consumption. Lavatories with flush-rimmed sinks or with an attached operable drinking fountain shall not be used for handwashing. Menu Posted – Item #526 *During the visit, Ms. Coffey posted the menu in the kitchen and at the front parent board. This was corrected during the visit. Use of Approved Curriculum – Item #1795 *To achieve compliance, an approved curriculum must be used and implemented with four year old children. The approved curricula list is on the Division’s NC Curriculum and Formative Assessment Review Process website- NC Curriculum and Formative Assessment Review Process - Curriculum. We discussed that although the facility is on a special provisional license, the four-star license subsidy reimbursement rate is still in effect and the curriculum must be in use give that the facility had a four star license prior to the special provisional license, and may be issued a four star license after the special provisional license. Employment Application – Item #1030 *To achieve compliance, KHM must complete an application for employment and provide verification of age. In addition, a plan must be created to state how new employees will have an employment application on file and verification of age by day one of employment. Schedule and activity plan – Items #415 and #425 *Ms. Coffey posted a schedule in space #2B during the visit. This was corrected during the visit. *To achieve compliance for the activity plans, current activity plans must be completed and posted in the three (3) classrooms #1, #2A, and #2B. We discussed that you are currently completing the activity plans for all three (3) classrooms. We discussed for you to train the teaching staff on how to create a lesson plan to allow you to take care of other administrative duties. Consultation is provided as follows: Due to the number of violations, a follow-up visit will be conducted. Due to time constraints, all violations could not be documented and entered in the Regulatory system. We discussed all violations verbally. A visit summary addendum will be completed tomorrow and emailed to you for review. The additional violations will be entered into the Regulatory system and you will have the same timeframe to achieve compliance for the violations, on or before 11/6/25. The annual compliance checklist will also be emailed to you tomorrow. Ms. Coffey stated there was a new phone number and email address for the child care facility. The phone number was changed from 828.389.3216 to 828.415.1567. The email address was changed from tinytoeslearningcenter01@gmail.com to tinytoeslearningcenter02@gmail.com. The asbestos survey has not been completed through the child care facility’s Clean Classrooms for Carolina Kids account to determine if asbestos testing is needed. The asbestos survey must be completed through the child care facility’s Clean Classrooms for Carolina Kids account. After reviewing the safe sleep policy, the Division’s sample was adopted and you will need to review the check boxes and decide what you are doing to accurately reflect the policy then follow the child care rule below to notify parents. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (d) If a center amends its safe sleep policy, it shall give written notice of the amendment to the parents of all enrolled infants aged 12 months or younger at least 14 days before the amended policy is implemented. Each parent shall sign a statement acknowledging the receipt and explanation of the amendment. The center shall retain the acknowledgement in the child's record as long as the child is enrolled at the center. The mop was removed from outdoor space #2. We discussed you will need to find a way to cover the sandbox. 15A NCAC 18A .2832 OUTDOOR LEARNING ENVIRONMENT AND PREMISES (c) For outdoor toys and play equipment, including all structures accessible to children, the following shall apply: (1) Equipment and toys shall be kept clean, in good repair, and free of peeling, flaking, or chalking paint, rust, and corrosion; and (2) A sandbox used in outdoor play shall be constructed to allow for drainage of water and shall be covered when not in use and kept clean. When new staff begin at the child care facility, it is required to have paperwork on file either prior to employment and on their first working day. Per North Carolina Child Care Licensing Rules (10A NCAC 09 .0514 – Personnel Records), all staff training documentation and personnel files must be maintained on site and be readily accessible for review. It is recommended that the administrator ensures that all staff files, including new hires, are complete and available on site before the staff member begins working, and that training worksheets are submitted to the licensing consultants in advance of scheduled visits. In space #2B, the teacher began employment yesterday. During observations, the teacher sat down most of the time. Since the teacher is still going through orientation, it is recommended to review the supervision rule below with the new staff. 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. New rated license rules went into effect on 7/1/25. We discussed the new rules and you are considering the options that apply to the child care facility; pathway 1, the program assessment option, or pathway 2, classroom instructional quality pathway. SECTION .3200 - STANDARDS FOR TWO THROUGH FIVE STAR RATED LICENSES It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Child Care Rule 10A NCAC 09 .3222 (c) If employment-related changes occur at a facility that result in noncompliance with or failure to meet the standards in the Section for the star rating issued, the operator shall correct the noncompliance within six months. If the operator does not correct the noncompliance within six months, the operator shall notify the Division. 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 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 monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0601 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MORGAN BROCK Operation Type: Center Case Number: 0425-110A Visit Date: 4/14/2025 Number Present: 19 Completed Date: 4/14/2025 Age: From 1 To 4 Total Minutes: 120 Time In: 11:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. Lori Herrick, Investigations Consultant, was also present during the visit. Lily Coffey, administrator, accompanied us during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Coffey. Limited monitoring of child care requirements occurred during today’s visit. The following violation was confirmed during today’s visit. Violation Number Comment Rule 301 Minimum staff/child ratios and group sizes for the number and ages of children in care were not met. Two staff members cared for fourteen children, ages one through four. GS 110-91(7);.0713(a-d) 303 Children were not adequately supervised at all times. On April 7, 2025, two staff members left the facility to go home and left an infant alone and unsupervised inside the facility. .1801(a)(1-5) 807 A safe indoor and outdoor environment was not provided for the children. On April 7, 2025, a staff member failed to provide a safe environment when the staff member did not use the safety straps on a bounce seat when an infant was inside the seat and lifted the bounce seat, while the infant was inside the seat, and placed the seat in a crib. The bounce seat's warning label stated to never leave the child unattended, not to move or lift the product with the child inside it, not to use it on an elevated surface, not to use on a bed or soft surface, and to always use the restraint system. 10A NCAC 09 .0601(a) 871 Center staff did not comply with the safe sleep policy. On April 7, 2025, a staff member failed to follow the safe sleep policy when a staff member placed a bounce seat with a sleeping infant inside a crib and left a blanket inside the crib. 10A NCAC 09 .0606(a) 1810 There was a substantiation of child maltreatment. On May 13, 2025, the Division determined child maltreatment based on the supervision needs of children. GS 110-105.6(a) Within one week (by April 21, 2025), you must submit documentation of the corrections you made and your plan to maintain compliance with the identified child care requirements to me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov. You may contact me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov, 828-788-0011 or Natosha Lambeth, Western Investigations Team Supervisor, natosha.lambeth@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0606 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MORGAN BROCK Operation Type: Center Case Number: 0425-110A Visit Date: 4/14/2025 Number Present: 19 Completed Date: 4/14/2025 Age: From 1 To 4 Total Minutes: 120 Time In: 11:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. Lori Herrick, Investigations Consultant, was also present during the visit. Lily Coffey, administrator, accompanied us during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Coffey. Limited monitoring of child care requirements occurred during today’s visit. The following violation was confirmed during today’s visit. Violation Number Comment Rule 301 Minimum staff/child ratios and group sizes for the number and ages of children in care were not met. Two staff members cared for fourteen children, ages one through four. GS 110-91(7);.0713(a-d) 303 Children were not adequately supervised at all times. On April 7, 2025, two staff members left the facility to go home and left an infant alone and unsupervised inside the facility. .1801(a)(1-5) 807 A safe indoor and outdoor environment was not provided for the children. On April 7, 2025, a staff member failed to provide a safe environment when the staff member did not use the safety straps on a bounce seat when an infant was inside the seat and lifted the bounce seat, while the infant was inside the seat, and placed the seat in a crib. The bounce seat's warning label stated to never leave the child unattended, not to move or lift the product with the child inside it, not to use it on an elevated surface, not to use on a bed or soft surface, and to always use the restraint system. 10A NCAC 09 .0601(a) 871 Center staff did not comply with the safe sleep policy. On April 7, 2025, a staff member failed to follow the safe sleep policy when a staff member placed a bounce seat with a sleeping infant inside a crib and left a blanket inside the crib. 10A NCAC 09 .0606(a) 1810 There was a substantiation of child maltreatment. On May 13, 2025, the Division determined child maltreatment based on the supervision needs of children. GS 110-105.6(a) Within one week (by April 21, 2025), you must submit documentation of the corrections you made and your plan to maintain compliance with the identified child care requirements to me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov. You may contact me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov, 828-788-0011 or Natosha Lambeth, Western Investigations Team Supervisor, natosha.lambeth@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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 110-105 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MORGAN BROCK Operation Type: Center Case Number: 0425-110A Visit Date: 4/14/2025 Number Present: 19 Completed Date: 4/14/2025 Age: From 1 To 4 Total Minutes: 120 Time In: 11:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. Lori Herrick, Investigations Consultant, was also present during the visit. Lily Coffey, administrator, accompanied us during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Coffey. Limited monitoring of child care requirements occurred during today’s visit. The following violation was confirmed during today’s visit. Violation Number Comment Rule 301 Minimum staff/child ratios and group sizes for the number and ages of children in care were not met. Two staff members cared for fourteen children, ages one through four. GS 110-91(7);.0713(a-d) 303 Children were not adequately supervised at all times. On April 7, 2025, two staff members left the facility to go home and left an infant alone and unsupervised inside the facility. .1801(a)(1-5) 807 A safe indoor and outdoor environment was not provided for the children. On April 7, 2025, a staff member failed to provide a safe environment when the staff member did not use the safety straps on a bounce seat when an infant was inside the seat and lifted the bounce seat, while the infant was inside the seat, and placed the seat in a crib. The bounce seat's warning label stated to never leave the child unattended, not to move or lift the product with the child inside it, not to use it on an elevated surface, not to use on a bed or soft surface, and to always use the restraint system. 10A NCAC 09 .0601(a) 871 Center staff did not comply with the safe sleep policy. On April 7, 2025, a staff member failed to follow the safe sleep policy when a staff member placed a bounce seat with a sleeping infant inside a crib and left a blanket inside the crib. 10A NCAC 09 .0606(a) 1810 There was a substantiation of child maltreatment. On May 13, 2025, the Division determined child maltreatment based on the supervision needs of children. GS 110-105.6(a) Within one week (by April 21, 2025), you must submit documentation of the corrections you made and your plan to maintain compliance with the identified child care requirements to me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov. You may contact me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov, 828-788-0011 or Natosha Lambeth, Western Investigations Team Supervisor, natosha.lambeth@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MORGAN BROCK Operation Type: Center Case Number: 0425-110A Visit Date: 4/14/2025 Number Present: 19 Completed Date: 4/14/2025 Age: From 1 To 4 Total Minutes: 120 Time In: 11:15 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. Lori Herrick, Investigations Consultant, was also present during the visit. Lily Coffey, administrator, accompanied us during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Coffey. Limited monitoring of child care requirements occurred during today’s visit. The following violation was confirmed during today’s visit. Violation Number Comment Rule 301 Minimum staff/child ratios and group sizes for the number and ages of children in care were not met. Two staff members cared for fourteen children, ages one through four. GS 110-91(7);.0713(a-d) 303 Children were not adequately supervised at all times. On April 7, 2025, two staff members left the facility to go home and left an infant alone and unsupervised inside the facility. .1801(a)(1-5) 807 A safe indoor and outdoor environment was not provided for the children. On April 7, 2025, a staff member failed to provide a safe environment when the staff member did not use the safety straps on a bounce seat when an infant was inside the seat and lifted the bounce seat, while the infant was inside the seat, and placed the seat in a crib. The bounce seat's warning label stated to never leave the child unattended, not to move or lift the product with the child inside it, not to use it on an elevated surface, not to use on a bed or soft surface, and to always use the restraint system. 10A NCAC 09 .0601(a) 871 Center staff did not comply with the safe sleep policy. On April 7, 2025, a staff member failed to follow the safe sleep policy when a staff member placed a bounce seat with a sleeping infant inside a crib and left a blanket inside the crib. 10A NCAC 09 .0606(a) 1810 There was a substantiation of child maltreatment. On May 13, 2025, the Division determined child maltreatment based on the supervision needs of children. GS 110-105.6(a) Within one week (by April 21, 2025), you must submit documentation of the corrections you made and your plan to maintain compliance with the identified child care requirements to me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov. You may contact me at Morgan Brock, Investigations Consultant, morgan.brock@dhhs.nc.gov, 828-788-0011 or Natosha Lambeth, Western Investigations Team Supervisor, natosha.lambeth@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0302 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0304 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0605 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0701 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .1102 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2802 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2809 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2818 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2830 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 5/8/2024 Number Present: 22 Completed Date: 5/8/2024 Age: From 0 To 4 Total Minutes: 150 Time In: 10:00 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of the third temporary time period visit at this program was to conduct limited monitoring of child care requirements. Lily Coffey, Administrator, was on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed and reviewed with you. The report was printed, signed, and provided to you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 4/15/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. Once the EPR training is completed, the EPR plan must be completed in the Risk Management Portal within four (4) months. The emergency medical care (EMC) plan was posted. An incident log was in use. The children were observed during outdoor play. There are no new staff. Limited monitoring of staff files occurred. The administrator would like to take the option to transition to a star-rated license based on the previous ownership’s star-rated license points. Based on the change of ownership, the facility would be included in Cohort 2. We discussed the resources available during the prep year and assessment year. Plan to visit the North Carolina Rated License Assessment Project (NCRLAP) website, ncrlap.org, for additional information, webinars, and resources. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 125 Daily records of arrival and departure times for children enrolled at the center were not maintained as children arrive and depart and/or were not made available for review. Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. 10A NCAC 09 .0302(d)(4) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. .0605(q) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. One (1) substitute staff had a health questionnaire on file dated 11/15/22. .0701(a) 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. One (1) existing staff had First Aid training expire on 4/30/24. .1102(c) 1049 All staff did not successfully complete certification in CPR training appropriate to the age of the children in care. Verification of staff completion of the CPR course from an approved training organization was not in the staff file. One (1) existing staff had CPR training expire on 4/30/24. .1102(d) Technical assistance for correction plan: Item #859 - The last documented monthly playground inspection was 3/4/24. Documentation for the monthly playground inspection for April 2024 could not be located. Playground inspections must be completed monthly. We discussed to have a reminder set on a calendar of your phone. If the inspection was misplaced, then it would be recommended to have a better system for filing directly after the inspection. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Item #125 - Seven (7) of twenty-two (22) children did not have documentation of their arrival times today. Ms. Coffey wrote in the arrival times for the seven (7) children during the visit. This was corrected during the visit. 10A NCAC 09 .0302 APPLICATION FOR A LICENSE FOR A CHILD CARE CENTER (d) During the pre-licensing visit the applicant shall have the following available for review pursuant to 10A NCAC 09 .0304(g): (4) daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart; 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (g) Each center shall maintain records as described in 10A NCAC 09 .0302(d) and shall make them available to the Division for review. Item #1034 - One (1) substitute staff had a health questionnaire on file dated 11/15/22. The substitute staff completed a new health questionnaire during the visit and dated 5/8/24. This was corrected during the visit. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director. Item Requirements: Health Questionnaire A statement signed by the staff member that indicates that the person is emotionally and physically fit to care for children. Due Date: Annually following the initial medical statement. #1048 - One (1) existing staff had First Aid training expire on 4/30/24. #1049 - One (1) existing staff had CPR training expire on 4/30/24. M. Allison must successfully complete First Aid and CPR training on or before 5/22/24. We discussed to plan ahead up to three (3) months in advance to renew any First Aid and CPR trainings. 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. (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. 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 5/22/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 79%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This is recommended to be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Pre-service requirements must be met for all positions. The facility will use the five (5) points for staff education based on the previous ownership. Program Standards: The facility will use the four (4) points for program standards based on the previous ownership. The facility will be included in Cohort 2 to resume the next rated license cycle. We discussed resources available during the visit today. The facility is meeting enhanced space and enhanced staff/child ratios. 10A NCAC 09 .2809 ENHANCED SPACE REQUIREMENTS (a) There shall be at least 30 square feet inside space per child per the total licensed capacity and 100 square feet outside space for each child using the outdoor learning environment at any one time. (b) There shall be an area that can be arranged for administrative and private conference activities. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (a) This Rule shall apply to evaluating the staff/child ratios and maximum group sizes for a rated license for child care centers. (b) The center shall comply with the following staff/child ratios and maximum group sizes. Age Ratio Staff/Children Maximum Group Size 0 to 12 Months 1/5 10 1 to 2 Years 1/6 12 2 to 3 Years 1/9 18 3 to 4 Years 1/10 20 4 to 5 Years 1/13 25 5 to 6 Years 1/15 25 6 Years and Older 1/20 25 Quality Point: The facility will use the one (1) quality point based on the previous ownership. Curriculum: There is not an approved curriculum being implemented by the facility. We discussed an approved curriculum must be implemented as of 6/1/24. The approved curriculum list was emailed to you today during the visit. This requirement will be monitored at the next licensing visit. 10A NCAC 09 .2802 APPLICATION FOR A TWO THROUGH FIVE STAR RATED LICENSE (d) Facilities with a four or five-star rated license that are licensed to serve four-year-old children shall implement a curriculum as defined in 10A NCAC 09 .0102(10) with their four year olds. The centers rated license assessment is due once every three years based on the date of the completed Environment Rating Scale scores, if applicable. During the three-year reassessment, the center’s program standards, staff education and a quality point option are determined to award the center’s star level. It is the center operator’s responsibility to maintain the same point level under each component at all times. If changes occur that may affect your rated license, please notify your licensing consultant to inform her of the changes and discuss a plan of action to maintain the center’s star rating. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a) A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. Consultation: It was discovered through an email on 4/18/24 from Jennifer Holloway, Engineer with the Department of Environmental Quality, that you must provide documentation that the water system was constructed prior to July 1, 1994 and has not been altered or expanded since that time. If documentation from the Department of Environmental Quality cannot be provided on or before 5/22/24, the statements below will be confirmed for the child care facility to not meet public water supply and have a restriction of twenty-four (24) persons due to the well water restriction. There are twenty-four (24) children enrolled currently and six (6) staff on-site on a regular basis. The child care facility will be limited to twenty-four (24) persons as of 6/1/24 and must reduce the number of persons on-site as of 6/1/24. We discussed that the restriction on the permit would be a capacity of eighteen (18) children and six (6) staff. If you would like change these capacity numbers, plan to email your request on or before 5/22/24. You must operate within these permit restrictions. If you would like to increase the capacity of the facility, you would need to work with the Department of Environmental Quality and an Engineer to meet public water supply requirements. 15A NCAC 18A .2815 WATER SUPPLY (a) A child care center's water supply shall meet the requirements of 15A NCAC 18C or 15A NCAC 18A .1700, as applicable. The operator of a child care center using a groundwater supply that serves 25 or more people shall provide the local health department serving the county in which the child care center is located with documentation from the Department of Environmental Quality, Division of Water Resources, Public Water Supply Section that the well meets the requirements of 15A NCAC 18C. In child care centers that use a non-community water supply, a water sample shall be collected by the Department once a year and submitted to the North Carolina State Laboratory of Public Health or other laboratory certified by the North Carolina State Laboratory of Public Health under 10A NCAC 42C .0102 to perform bacteriological examinations. The Department may collect additional samples for tests of water quality, as indicated by possible additional sources of contamination. We discussed the annual fire inspection is due on or before 11/27/24. You will need to contact the local Fire Marshal for the annual inspection. The original approved inspection must be mailed to the child care consultant within one week. Reminder that the Fire Marshal must also monitor the auxiliary spaces. 10A NCAC 09 .0304 ON-GOING REQUIREMENTS FOR A LICENSE (a) Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division. We discussed that a pack and play brought in by parents cannot be used. The cribs supplied by the child care facility must be used. We discussed that D. Fulgham must enrolled in EDU 119 by 6/1/24 since she is the lead teacher Monday through Thursday in space #1, the classroom with two, three, and four year old children. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/. It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0510 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 3/18/2024 Number Present: 20 Completed Date: 3/18/2024 Age: From 0 To 4 Total Minutes: 180 Time In: 09:45 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit. This facility is on a temporary license due to a change of ownership. Lily Coffey, Administrator, was on-site and available to answer and ask questions. The report was reviewed with you, printed, signed, and a copy left with you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 3/4/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The children were observed in free play, outdoor play, routine care, lunch, and rest. The lunch today was a hotdog with bun, potatoes, pears, and milk. Applesauce was on the menu and the menu was documented with the change of pears. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in Cohort 2 of the rated license cycle. Information will be forthcoming as the prep year and assessment year approaches. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 475 Sand and water play activities were not available weekly to each group. Per staff reports, water play is not currently offered to children ages three and older in space #1. .0510(c)(3) 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. Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. .0604(q) Technical assistance for correction plan: Item #849 – Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. We discussed that the expiration date for diaper creams can be documented on the medication authorization form. It is recommended for staff to review all diaper creams at least monthly to check expiration dates. 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. Corrected During the Visit Item #858 – In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. Any choking hazards must be stored at five feet or higher, or locked. We discussed that there were many age appropriate cars to play with in blocks without the small toy cars. The toy cars were moved to make them inaccessible to children. We discussed to keep the soft plastic wipes containers above five feet in the diaper cubbies. The soft plastic wipes containers were moved to make them inaccessible to children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Item #475 – Per staff reports, water play is not currently offered to children ages three and older in space #1. Water play must be offered at least weekly. We discussed one or two small containers of water with water play toys could be introduced with children if a water play table is not on-site. 10A NCAC 09 .0510 ACTIVITY AREAS (c) Each center shall provide materials and opportunities for each group of children at least weekly, indoors or outdoors, for the following: (1) music and rhythm; (2) science and nature; and (3) sand and water play. 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 4/1/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history prior to the visit today was 74%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. All staff must have their education evaluated by WORKS. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: Applying for a two through five-star rated license and have the Environment Rating Scale (ERS) assessment is voluntary. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. There is not a curriculum on-site being implemented as of today. Consultation: N. Knotts has CPR and First Aid training through NationalCPRFoundation, which is not an approved agency through the Division of Child Development and Early Education (DCDEE). We discussed that Ms. Knotts has until 5/19/24 to take age appropriate CPR and First Aid through an approved agency and approved course. N. Knotts has until 5/19/24 to complete the Recognizing and Responding to Suspicions of Child Maltreatment. M. Alice has CPR and First Aid training expiring in April 2024. A. Lee has CPR and First Aid training expiring in July 2024. We discussed a thermometer needs to be added to any classroom with children 12 months or younger to keep track of the temperature between 68 and 75 degrees Fahrenheit. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0604 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 3/18/2024 Number Present: 20 Completed Date: 3/18/2024 Age: From 0 To 4 Total Minutes: 180 Time In: 09:45 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit. This facility is on a temporary license due to a change of ownership. Lily Coffey, Administrator, was on-site and available to answer and ask questions. The report was reviewed with you, printed, signed, and a copy left with you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 3/4/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The children were observed in free play, outdoor play, routine care, lunch, and rest. The lunch today was a hotdog with bun, potatoes, pears, and milk. Applesauce was on the menu and the menu was documented with the change of pears. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in Cohort 2 of the rated license cycle. Information will be forthcoming as the prep year and assessment year approaches. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 475 Sand and water play activities were not available weekly to each group. Per staff reports, water play is not currently offered to children ages three and older in space #1. .0510(c)(3) 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. Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. .0604(q) Technical assistance for correction plan: Item #849 – Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. We discussed that the expiration date for diaper creams can be documented on the medication authorization form. It is recommended for staff to review all diaper creams at least monthly to check expiration dates. 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. Corrected During the Visit Item #858 – In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. Any choking hazards must be stored at five feet or higher, or locked. We discussed that there were many age appropriate cars to play with in blocks without the small toy cars. The toy cars were moved to make them inaccessible to children. We discussed to keep the soft plastic wipes containers above five feet in the diaper cubbies. The soft plastic wipes containers were moved to make them inaccessible to children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Item #475 – Per staff reports, water play is not currently offered to children ages three and older in space #1. Water play must be offered at least weekly. We discussed one or two small containers of water with water play toys could be introduced with children if a water play table is not on-site. 10A NCAC 09 .0510 ACTIVITY AREAS (c) Each center shall provide materials and opportunities for each group of children at least weekly, indoors or outdoors, for the following: (1) music and rhythm; (2) science and nature; and (3) sand and water play. 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 4/1/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history prior to the visit today was 74%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. All staff must have their education evaluated by WORKS. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: Applying for a two through five-star rated license and have the Environment Rating Scale (ERS) assessment is voluntary. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. There is not a curriculum on-site being implemented as of today. Consultation: N. Knotts has CPR and First Aid training through NationalCPRFoundation, which is not an approved agency through the Division of Child Development and Early Education (DCDEE). We discussed that Ms. Knotts has until 5/19/24 to take age appropriate CPR and First Aid through an approved agency and approved course. N. Knotts has until 5/19/24 to complete the Recognizing and Responding to Suspicions of Child Maltreatment. M. Alice has CPR and First Aid training expiring in April 2024. A. Lee has CPR and First Aid training expiring in July 2024. We discussed a thermometer needs to be added to any classroom with children 12 months or younger to keep track of the temperature between 68 and 75 degrees Fahrenheit. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0803 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 3/18/2024 Number Present: 20 Completed Date: 3/18/2024 Age: From 0 To 4 Total Minutes: 180 Time In: 09:45 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit. This facility is on a temporary license due to a change of ownership. Lily Coffey, Administrator, was on-site and available to answer and ask questions. The report was reviewed with you, printed, signed, and a copy left with you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 3/4/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The children were observed in free play, outdoor play, routine care, lunch, and rest. The lunch today was a hotdog with bun, potatoes, pears, and milk. Applesauce was on the menu and the menu was documented with the change of pears. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in Cohort 2 of the rated license cycle. Information will be forthcoming as the prep year and assessment year approaches. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 475 Sand and water play activities were not available weekly to each group. Per staff reports, water play is not currently offered to children ages three and older in space #1. .0510(c)(3) 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. Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. .0604(q) Technical assistance for correction plan: Item #849 – Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. We discussed that the expiration date for diaper creams can be documented on the medication authorization form. It is recommended for staff to review all diaper creams at least monthly to check expiration dates. 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. Corrected During the Visit Item #858 – In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. Any choking hazards must be stored at five feet or higher, or locked. We discussed that there were many age appropriate cars to play with in blocks without the small toy cars. The toy cars were moved to make them inaccessible to children. We discussed to keep the soft plastic wipes containers above five feet in the diaper cubbies. The soft plastic wipes containers were moved to make them inaccessible to children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Item #475 – Per staff reports, water play is not currently offered to children ages three and older in space #1. Water play must be offered at least weekly. We discussed one or two small containers of water with water play toys could be introduced with children if a water play table is not on-site. 10A NCAC 09 .0510 ACTIVITY AREAS (c) Each center shall provide materials and opportunities for each group of children at least weekly, indoors or outdoors, for the following: (1) music and rhythm; (2) science and nature; and (3) sand and water play. 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 4/1/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history prior to the visit today was 74%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. All staff must have their education evaluated by WORKS. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: Applying for a two through five-star rated license and have the Environment Rating Scale (ERS) assessment is voluntary. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. There is not a curriculum on-site being implemented as of today. Consultation: N. Knotts has CPR and First Aid training through NationalCPRFoundation, which is not an approved agency through the Division of Child Development and Early Education (DCDEE). We discussed that Ms. Knotts has until 5/19/24 to take age appropriate CPR and First Aid through an approved agency and approved course. N. Knotts has until 5/19/24 to complete the Recognizing and Responding to Suspicions of Child Maltreatment. M. Alice has CPR and First Aid training expiring in April 2024. A. Lee has CPR and First Aid training expiring in July 2024. We discussed a thermometer needs to be added to any classroom with children 12 months or younger to keep track of the temperature between 68 and 75 degrees Fahrenheit. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 3/18/2024 Number Present: 20 Completed Date: 3/18/2024 Age: From 0 To 4 Total Minutes: 180 Time In: 09:45 AM Time Out: 12:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit. This facility is on a temporary license due to a change of ownership. Lily Coffey, Administrator, was on-site and available to answer and ask questions. The report was reviewed with you, printed, signed, and a copy left with you. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. The last monthly fire drill was documented as practiced on 3/4/24. The last monthly playground inspection was completed on 3/4/24. The last sanitation inspection was completed on 2/7/24 with twelve (12) demerits for a Superior rating. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies have been reviewed and meet all required topics. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The children were observed in free play, outdoor play, routine care, lunch, and rest. The lunch today was a hotdog with bun, potatoes, pears, and milk. Applesauce was on the menu and the menu was documented with the change of pears. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in Cohort 2 of the rated license cycle. Information will be forthcoming as the prep year and assessment year approaches. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations of child care requirements were observed: Violation Number Comment Rule 475 Sand and water play activities were not available weekly to each group. Per staff reports, water play is not currently offered to children ages three and older in space #1. .0510(c)(3) 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. Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. .0803(12) 858 Plastic bags, materials that could be torn apart and toy parts small enough to be swallowed were accessible to children under three years of age. In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. .0604(q) Technical assistance for correction plan: Item #849 – Boudreaux’s Butt Paste diaper rash ointment in space #2A, the classroom with infants and toddlers, expired in February 2024 and was not sent home or discarded within 72 hours. We discussed that the expiration date for diaper creams can be documented on the medication authorization form. It is recommended for staff to review all diaper creams at least monthly to check expiration dates. 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. Corrected During the Visit Item #858 – In space #1, the classroom with two through four year old children, there were small toy cars that had small toy parts in the block area below five feet and accessible to children under three years of age. In space #2A, there were three (3) soft plastic wipes containers that were stored below five feet and were accessible to children under three years of age. Any choking hazards must be stored at five feet or higher, or locked. We discussed that there were many age appropriate cars to play with in blocks without the small toy cars. The toy cars were moved to make them inaccessible to children. We discussed to keep the soft plastic wipes containers above five feet in the diaper cubbies. The soft plastic wipes containers were moved to make them inaccessible to children. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (q) Plastic bags, toys, toy parts small enough to be swallowed, and materials that can be torn apart, such as foam rubber and styrofoam, shall not be accessible to children under three years of age. However, styrofoam plates and larger pieces of foam rubber may be used for supervised art activities and styrofoam plates may be used for food service. Jump ropes and rubber bands shall not be accessible to children under five years of age without adult supervision. Balloons shall be prohibited for children of all ages. Item #475 – Per staff reports, water play is not currently offered to children ages three and older in space #1. Water play must be offered at least weekly. We discussed one or two small containers of water with water play toys could be introduced with children if a water play table is not on-site. 10A NCAC 09 .0510 ACTIVITY AREAS (c) Each center shall provide materials and opportunities for each group of children at least weekly, indoors or outdoors, for the following: (1) music and rhythm; (2) science and nature; and (3) sand and water play. 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 4/1/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history prior to the visit today was 74%. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. All staff must have their education evaluated by WORKS. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: Applying for a two through five-star rated license and have the Environment Rating Scale (ERS) assessment is voluntary. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. There is not a curriculum on-site being implemented as of today. Consultation: N. Knotts has CPR and First Aid training through NationalCPRFoundation, which is not an approved agency through the Division of Child Development and Early Education (DCDEE). We discussed that Ms. Knotts has until 5/19/24 to take age appropriate CPR and First Aid through an approved agency and approved course. N. Knotts has until 5/19/24 to complete the Recognizing and Responding to Suspicions of Child Maltreatment. M. Alice has CPR and First Aid training expiring in April 2024. A. Lee has CPR and First Aid training expiring in July 2024. We discussed a thermometer needs to be added to any classroom with children 12 months or younger to keep track of the temperature between 68 and 75 degrees Fahrenheit. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2215 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 22 Completed Date: 1/30/2024 Age: From 0 To 4 Total Minutes: 115 Time In: 10:35 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during an unannounced follow-up visit on 1/17/24 and provide limited monitoring of child care requirements. Sidney McCrory, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on site and available to ask and answer questions. Kaitlin Frady, Legal Operator, and Mandy Mills, Clay County Child Care Health Consultant, were also on-site. During the unannounced follow-up visit on 1/17/24, five (5) violations were cited. The children were observed during free play and routine care. The violations documented on 1/17/24 were monitored and discussed as follows: #316 – Infants under 12 months of age were not grouped with two year old children during the visit today. A letter of correction is due on or before 1/31/24. Item #714 – The fence has been replaced with a five (5) foot fence on playground spaces #1 and #2. There is no longer a gap between the ground and fencing on playground space #2. A letter of correction is due on or before 1/31/24. Item #824 – The fence has been replaced with a five (5) foot fence on playground spaces #1 and #2. No height has been added to the fencing of playground space #3. It is recommended to remove playground space #3 from licensed outdoor space. In the meantime, no children will use playground space #3. A letter of correction is due on or before 1/31/24. #848 – There were no medications for children in the unlocked medication box today. The facility has changed their medication policy to state that no over the counter medications will be administered to children without a doctor’s note. A letter of correction is due on or before 1/31/24. Item #899 – The door in space #2A was locked and the doorknob were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. A letter of correction is due on or before 1/31/24. This is a repeat violation from 1/17/24. Staff child/ratio was as follows today: Space #2A had one (1) teacher and two (2) infants under 12 months of age. Space #2B had had two (2) teachers and eight (8) children with one and two year old children. Space #1 had two (2) teachers and twelve (12) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A teacher medication, After-Bite anti-itch medication, was stored in an unlocked medication box in space #2A. 15A NCAC 18A .2820(d) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Item #899 – The doors in space #2A was locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. This is a repeat violation from 1/17/14. GS 110-91 Technical assistance for correction plan: Item #899 – The doors in space #2A was locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. A letter of correction is due on or before 1/31/24. This is a repeat violation from 1/17/14. Doors to Remain Unlocked for Egress – Corrected During the Visit *Since the locks are not single action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. We discussed the doors will remain unlocked until the door handles can be replaced with single action locks. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. #841 – A teacher medication, After-Bite anti-itch medication, was stored in an unlocked medication box in space #2A. Medication Storage – Corrected During the Visit The over the counter medication, After-Bite anti-itch medication, was taken out of the unlocked medication box and the staff member took it to her vehicle. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed Rustoleum would be used to cover any rust spots in the dividing fence between playground spaces #1 and #2. We discussed that a medication training and hand washing training is being set up with Mandy Mills in the near future. The pre-service for administrators form for Lily Coffey was collected during the visit today. We discussed that the facility would like assistance from the infant-toddler specialist, Hope Buckner. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 22 Completed Date: 1/30/2024 Age: From 0 To 4 Total Minutes: 115 Time In: 10:35 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during an unannounced follow-up visit on 1/17/24 and provide limited monitoring of child care requirements. Sidney McCrory, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on site and available to ask and answer questions. Kaitlin Frady, Legal Operator, and Mandy Mills, Clay County Child Care Health Consultant, were also on-site. During the unannounced follow-up visit on 1/17/24, five (5) violations were cited. The children were observed during free play and routine care. The violations documented on 1/17/24 were monitored and discussed as follows: #316 – Infants under 12 months of age were not grouped with two year old children during the visit today. A letter of correction is due on or before 1/31/24. Item #714 – The fence has been replaced with a five (5) foot fence on playground spaces #1 and #2. There is no longer a gap between the ground and fencing on playground space #2. A letter of correction is due on or before 1/31/24. Item #824 – The fence has been replaced with a five (5) foot fence on playground spaces #1 and #2. No height has been added to the fencing of playground space #3. It is recommended to remove playground space #3 from licensed outdoor space. In the meantime, no children will use playground space #3. A letter of correction is due on or before 1/31/24. #848 – There were no medications for children in the unlocked medication box today. The facility has changed their medication policy to state that no over the counter medications will be administered to children without a doctor’s note. A letter of correction is due on or before 1/31/24. Item #899 – The door in space #2A was locked and the doorknob were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. A letter of correction is due on or before 1/31/24. This is a repeat violation from 1/17/24. Staff child/ratio was as follows today: Space #2A had one (1) teacher and two (2) infants under 12 months of age. Space #2B had had two (2) teachers and eight (8) children with one and two year old children. Space #1 had two (2) teachers and twelve (12) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A teacher medication, After-Bite anti-itch medication, was stored in an unlocked medication box in space #2A. 15A NCAC 18A .2820(d) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Item #899 – The doors in space #2A was locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. This is a repeat violation from 1/17/14. GS 110-91 Technical assistance for correction plan: Item #899 – The doors in space #2A was locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. A letter of correction is due on or before 1/31/24. This is a repeat violation from 1/17/14. Doors to Remain Unlocked for Egress – Corrected During the Visit *Since the locks are not single action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. We discussed the doors will remain unlocked until the door handles can be replaced with single action locks. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. #841 – A teacher medication, After-Bite anti-itch medication, was stored in an unlocked medication box in space #2A. Medication Storage – Corrected During the Visit The over the counter medication, After-Bite anti-itch medication, was taken out of the unlocked medication box and the staff member took it to her vehicle. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed Rustoleum would be used to cover any rust spots in the dividing fence between playground spaces #1 and #2. We discussed that a medication training and hand washing training is being set up with Mandy Mills in the near future. The pre-service for administrators form for Lily Coffey was collected during the visit today. We discussed that the facility would like assistance from the infant-toddler specialist, Hope Buckner. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
GS 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/30/2024 Number Present: 22 Completed Date: 1/30/2024 Age: From 0 To 4 Total Minutes: 115 Time In: 10:35 AM Time Out: 12:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during an unannounced follow-up visit on 1/17/24 and provide limited monitoring of child care requirements. Sidney McCrory, Child Care Consultant, accompanied me on the visit. Lily Coffey, Administrator, was on site and available to ask and answer questions. Kaitlin Frady, Legal Operator, and Mandy Mills, Clay County Child Care Health Consultant, were also on-site. During the unannounced follow-up visit on 1/17/24, five (5) violations were cited. The children were observed during free play and routine care. The violations documented on 1/17/24 were monitored and discussed as follows: #316 – Infants under 12 months of age were not grouped with two year old children during the visit today. A letter of correction is due on or before 1/31/24. Item #714 – The fence has been replaced with a five (5) foot fence on playground spaces #1 and #2. There is no longer a gap between the ground and fencing on playground space #2. A letter of correction is due on or before 1/31/24. Item #824 – The fence has been replaced with a five (5) foot fence on playground spaces #1 and #2. No height has been added to the fencing of playground space #3. It is recommended to remove playground space #3 from licensed outdoor space. In the meantime, no children will use playground space #3. A letter of correction is due on or before 1/31/24. #848 – There were no medications for children in the unlocked medication box today. The facility has changed their medication policy to state that no over the counter medications will be administered to children without a doctor’s note. A letter of correction is due on or before 1/31/24. Item #899 – The door in space #2A was locked and the doorknob were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. A letter of correction is due on or before 1/31/24. This is a repeat violation from 1/17/24. Staff child/ratio was as follows today: Space #2A had one (1) teacher and two (2) infants under 12 months of age. Space #2B had had two (2) teachers and eight (8) children with one and two year old children. Space #1 had two (2) teachers and twelve (12) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A teacher medication, After-Bite anti-itch medication, was stored in an unlocked medication box in space #2A. 15A NCAC 18A .2820(d) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. Item #899 – The doors in space #2A was locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. This is a repeat violation from 1/17/14. GS 110-91 Technical assistance for correction plan: Item #899 – The doors in space #2A was locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. This was corrected during the visit. A letter of correction is due on or before 1/31/24. This is a repeat violation from 1/17/14. Doors to Remain Unlocked for Egress – Corrected During the Visit *Since the locks are not single action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. We discussed the doors will remain unlocked until the door handles can be replaced with single action locks. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. #841 – A teacher medication, After-Bite anti-itch medication, was stored in an unlocked medication box in space #2A. Medication Storage – Corrected During the Visit The over the counter medication, After-Bite anti-itch medication, was taken out of the unlocked medication box and the staff member took it to her vehicle. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed Rustoleum would be used to cover any rust spots in the dividing fence between playground spaces #1 and #2. We discussed that a medication training and hand washing training is being set up with Mandy Mills in the near future. The pre-service for administrators form for Lily Coffey was collected during the visit today. We discussed that the facility would like assistance from the infant-toddler specialist, Hope Buckner. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0803 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0605 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0713 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0803 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2215 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
GS 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/17/2024 Number Present: 15 Completed Date: 1/17/2024 Age: From 0 To 3 Total Minutes: 125 Time In: 12:40 PM Time Out: 02:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Unannounced Visit Follow-Up Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance for violations that were cited during a Temporary Time Period visit on 1/3/24 and provide limited monitoring of child care requirements. Mary Alison, Administrator, and Lily Coffey, Assistant Director, were on site and available to ask and answer questions. During the Temporary Time Period visit on 1/3/24, nineteen (19) violations were cited. The children were observed during routine care, free play, and outdoor play today. The violations documented on 1/3/24 were monitored and discussed as follows: Item #102 – The current temporary license was observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #319 – The staff/child ratio charts were posted in spaces #1, #2A, and #2B with documentation on the chart to specify the applicable staff/child ratio for the classroom and for parents to view. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #428 – Activity plans in spaces #1, #2A, and #2B were current and dated for the month of January 2024 week of 1/15/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #541 – The written feeding plans included the date received by the center and had parent signatures. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #714 – The bottom part of the fencing on playground space #2 has not been closed to less than 3.5 inches. The gap at the bottom of the fencing measured six (6) inches today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #721 – The climbing equipment on outdoor space #3 has a temporary cap with soft black tape on the climbing structure and the crack in the metal pole has been covered with soft black tape, which is covering the crack and rust. Per Ms. Coffey, outdoor spaces #3 and #1 are not being used by children until final repairs can be made, including the rust on outdoor space #1. Outdoor space #2 is being used for all children and the outdoor play schedule is staggered to allow one class at a time to use playground space #2. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #802 – Safe pick-up and delivery procedures were observed posted at the front bulletin board today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #805 – A fire drill was practiced on 1/4/24. A plan has been made to schedule the fire drills on a particular day of the calendar at the start of each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #824 –No height has been added to the fencing of any outdoor spaces #1, #2, or #3. It is recommended to add height to playground with lattice or something similar that is stiff. Per Ms. Coffey, a new fence for all playground spaces is due to be installed within three (3) weeks. A letter of compliance with a statement regarding this violation was received on 1/16/24. This is a repeat violation. Item #841 – This was corrected during the visit on 1/3/24. Item #847 – Parent medication authorizations were reviewed today for Desitin and a diaper cream spray. The Infant Tylenol in use had a parent medication authorization. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #849 – This was corrected during the visit on 1/3/24. Item #859 – The last monthly playground inspection was completed on 1/4/24. A plan has been made to schedule the fire drills and the playground inspection on the same day each month. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #871 – The sleep charts for infants aged 12 months or younger were reviewed today and were verified to have checks at least every 15 minutes. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #887 – Documentation of sleep charts were from 1/4/24 to 1/17/24, since the visit on 1/3/24. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #892 – The safe sleep policy was posted in spaces #2A and #2B, the classrooms with children ages 12 months and younger. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1032 – The medical report for M. Allison dated 1/4/24 and the medical report for H. Moody dated 12/11/23 were reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Items #1033 – The TB test/screening for M. Allison dated 1/4/24 was reviewed and on file today. A letter of compliance with a statement regarding this violation was received on 1/16/24. Item #1908 – One (1) child file was reviewed and verified that the acknowledgement of the prevention of shaken baby and abusive head trauma policy had been reviewed, dated 12/6/23, and was on file. A letter of compliance with a statement regarding this violation was received on 1/16/24. Staff child/ratio was as follows today: Space #2A was not in use by children except for diaper changing. Space #2B had had two (2) teachers and nine (9) children with infants under 12 months, one year old children, and a two year old child. Space #1 had one (1) teacher and six (6)) two through three year old children. There following violations of child care requirements was observed: Violation Number Comment Rule 316 Children under one year of age were not kept separate from children two years and older. Two (2) infants under 12 months of age were grouped in a classroom with a two-year-old child. 10A NCAC 09 .0713(a)(5) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing on playground space #2 has been mangled and a gap of approximately six (6) inches has formed. This is a repeat violation from 1/3/24. .0605(g) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. The opening at the bottom of the fence of outdoor space #2 is six (6) inches and has not been reduced to less than 3.5 inches. This is a repeat violation from the 1/3/24 visit. GS 110-91(6); .0605((i) 848 Questionable medication instructions from parents were followed without signed written dosage instructions received from physician or authorized health professional. Infant Tylenol was administered to a one year old child on 1/16/24, when the manufacturer's labeled instructions stated to ask a doctor when giving to children under two years of age. A doctor's note did not accompany the parent medication authorization form. 10A NCAC 09 .0803(5) 899 The child care operator did not comply with all State laws, federal laws and/or local ordinances that pertain to child health, safety, and welfare, as required by General Statute 110-91. The doors in spaces #1, #2A, and #2B were locked and the doorknobs were not self-unlocking. This does not meet North Carolina Fire Code for egress. GS 110-91 Technical assistance for correction plan: Grouping of infants with two year old children *Children under 12 months of age cannot be grouped with two year old children except for at the first operating hour of the day and the last operating hour of the operating day. The two year old child today transitioned from space #2B to space #1 during the visit. A follow-up visit is required for this violation. Reference the child care rule below. 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (2) children of all ages may be cared for together in groups for the first and last operating hour of the day, provided the staff/child ratio for the youngest child in the group is maintained; (3) a child two years of age and older may be placed with children under one year of age when a physician certifies that the developmental age of the child makes this placement appropriate; (5) except as provided in Subparagraphs (2) and (3) of this Paragraph, children under one year of age shall be kept separate from children two years of age and over; Questionable Medication *Plan to review the medication’s manufacturer label for instructions when accepting medications from parents with medication authorizations. It is recommended to have all staff attend medication administration training from Mandy Mills, Child Care Health Consultant. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (5) When questions arise concerning whether any medication should be administered to a child, the caregiver may decline to administer that medication without signed, written dosage instructions from a licensed physician or authorized health professional. Doors to Remain Unlocked for Egress *Since the locks are not singe action/self-unlocking, then the locks must remain unlocked when the building is occupied. It is recommended to contact Anthony Stillwell, Clay County Building and Fire Inspector, if you would like to change the locks to single action/self-locking to determine what is approved to meet North Carolina Building and Fire Codes. § 110-91. Mandatory standards for a license. (5) Fire Prevention. – Each child care facility shall be located in a building that meets appropriate requirements for fire prevention and safe evacuation that apply to child care facilities as established by the Department of Insurance in consultation with the Department. Except for child care centers located on State property, each child care center shall be inspected at least annually by a local fire department or volunteer fire department for compliance with these requirements. Child care centers located on State property shall be inspected at least annually by an official designated by the Department of Insurance. Outdoor Fencing – Repeat Violation **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed all the fencing will be replaced with three (3) weeks to a five-foot fence. Outdoor spaces #1 and #3 will not be used until the fencing has been replaced. Outdoor space #2 must be modified in the areas where the fence is below four (4) feet in height to allow for the children to use this as outdoor space and until the fence replaced to meet four (4) feet in height in all outdoor spaces. It is recommended to use lattice or similar stiff material without protrusions to raise the height of the fence. The opening at the bottom of the fence on outdoor space #2 must be less than 3.5 inches. It is recommended to use lattice on the outside of the fence with zip ties to close the gap to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. 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 1/31/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive it by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. The compliance history for the facility prior to the visit today was 71%. 10A NCAC 09 .2215 DENIAL OF A LICENSE (a) The Secretary may deny an application for a child care facility license or the issuance of any permit to operate a child care facility under the following circumstances: (8) based on the operator’s non-compliance with the requirements of G.S. 110, Article 7, 10A NCAC 10, or this Chapter, during a temporary licensure period; Consultation: We discussed that the policy acknowledgement for staff and children files must be dated. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0102 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
Open Not marked corrected in the state record
Category: supervision. Open / not marked corrected.
10A NCAC 09 .0302 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0508 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0601 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0604 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0605 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0606 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0608 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0701 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0803 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .0902 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .1003 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
10A NCAC 09 .2818 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-90 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
G.S. 110-99 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
GS 110-91 · Violation
Name of Operation: TINY TOES LEARNING CENTER HAYESVILLE LLC Facility ID: 22000028 Consultant: MONICA HOUCK Operation Type: Center Case Number: Visit Date: 1/3/2024 Number Present: 16 Completed Date: 1/3/2024 Age: From 0 To 3 Total Minutes: 375 Time In: 10:00 AM Time Out: 04:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time period visit. This facility is on a temporary license due to a change of ownership. Mary Allison, Administrator, and Lily Coffey, Assistant Director, were on-site and available to answer and ask questions. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Monica Houck, Lead Child Care Consultant and signed by Lily Coffey, during the visit. An electronic signed copy of the visit summary was electronically emailed to Kaitlin Frady, Legal Operator, and Lily Coffey. Currently this center operates with a Temporary License, issued 12/1/23 and is effective through 6/1/24. The restrictions include daytime care only; meets enhanced space; meets enhanced ratios; maximum capacity twenty-nine (29) children; and age range; 0-5 years. The Secretary of State website was reviewed today, and the Limited Liability Company, Tiny Toes Learning Center Hayesville LLC, is listed as active-current. If any changes to the organization need to be made or you decide to sell your business, then you must notify your consultant at least thirty (30) days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. During this first Temporary Time Period visit, all classrooms were monitored as well as the playground, materials, equipment and required posted items for meeting all minimum licensing requirements. The last monthly fire drill was documented as practiced on 11/15/23. The last shelter-in-place drill or lockdown drill was practiced on 8/29/23. Monthly playground inspections could not be located. The last sanitation inspection was completed on 9/11/23 with twelve (12) demerits for a Superior rating. A sanitation inspection under the new ownership must be completed prior to the expiration of the temporary license. An approved fire inspection was completed on 11/27/23. An approved building inspection was completed on 11/28/23. A zoning letter for the facility was completed and dated 11/28/23. Administrative, operational, and personnel policies must meet all required topics. All policies must be submitted for review and meet all required topics prior to the expiration of the temporary license. The Emergency Preparedness Response (EPR) training must be completed by one (1) staff on or before 12/1/24. The emergency medical care (EMC) plan was posted. The incident log was in use. The children were observed during routine care, free play, lunch, and rest time. Lunch was ham and cheese sandwiches, French fries, pears, and milk as noted on the menu. Three (3) children files were monitored. There are six (6) staff. Six (6) staff files were monitored. To continue to serve children on subsidy vouchers, the facility must transition to a three-star license or higher. If the facility cannot achieve a three-star license or higher, no children can be served that receive subsidy vouchers. Due to the ownership change, the facility has the option to use the previous ownership’s four-star rating and be included in the rated license cycle for the previous facility, Cohort 2. Information will be forthcoming when approaching the prep year and assessment year. It is voluntary to apply for a two through five star rated license. The temporary license is effective through 6/1/24. The Initial Application for Assessment for a Two Component Star Rated License can be found on the Division’s website if you would like to apply for a rated license and the Rated License Request for Review Form can be requested if you would like to request the Environment Rating Scale (ERS) assessment. Plan to visit the ncrlap.org website to learn more about the assessment process. You may also request an Outreach Assessment while waiting for the prep year for the facility. 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 102 The license was not posted in a prominent place at all times. The temporary license for Tiny Toes Learning Center Hayesville LLC was not posted. The facility ownership has changed from a sole proprietorship to a Limited Liability Company since the issuance of the first temporary license for Tiny Toes Learning Center. G.S. 110-99(a1) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio chart in all classrooms, did not specify the applicable staff/child ratio for the classroom for parents to view. .0713(a)(10), (c) & (f)(3); .2818(e) 428 A current activity plan was not posted for each group of children for reference. A current activity plan was not posted in spaces #1, #2A, or #2B. GS 110-91(12); .0508(a) 541 The written feeding plan did not include the child's name, parent signature, and/or was not dated when received by the center. Three (3) feeding plans did not have documentation of the date it was received and one (1) feeding plan did not have a parent signature. .0902(a) 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. The bottom part of the fencing non playground space #2 has been mangled and a gap of approximately six (6) inches has formed. .0605(g) 721 All equipment and furnishings were not in good repair. The climbing equipment on outdoor space #3 is missing a cap from a pole on the equipment and has an approximate three to four inch crack in the metal pole, causing it to have sharp rusty edges. The fence located on outdoor space #3 has rust in various places. G.S. 110-91(6); .0601(b) 802 Safe pick-up and delivery procedures were not communicated to parents and/or were not posted where they can be seen by the parents. Safe pick up and delivery procedures were not posted. .1003(b) 805 Fire drills were not practiced monthly and/or the drill record was incomplete. The last documented fire drill practiced was 11/15/23. .0604(t); .0302(d)(5) 824 Outdoor play area was not enclosed by fence with a minimum height of 4 feet. The top of the fence, less than six feet, was not free from protrusions. The fences on playground spaces #1, #2, and #3 had areas of the fence that measured as low as three (3) feet, eight (8) inches. GS 110-91(6); .0605((i) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. Prescription medication, Nystatin, was stored unlocked and above five feet. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. One (1) diaper cream, Destin, did not have a medication authorization form to state the name of the medication and the amount to apply. One (1) diaper cream spray did not have a medication authorization form to state the name of the medication and the amount to apply. There was a Tylenol and Ibuprofen that requires updated authorization forms. 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. Nystatin was located in space #2A for a child that no longer attends the facility. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. A monthly playground inspection was not completed for December 2023. .0605(q) 871 Center staff did not comply with the safe sleep policy. On 12/18/23, one (1) child twelve months or younger had documentation of sleep from 11:47am-12:37pm, instead of every 15 minutes as required. One 12/18/23, one (1) child twelve months or younger had documentation of sleep from 10:31am-10:48am and 11:34am-12:36pm, instead of every fifteen minutes as required. 10A NCAC 09 .0606(a) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. One (1) month of documented sleep checks could not be located during the visit. .0606(g) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. The safe sleep policy was not posted in spaces #2A or #2B, the classrooms with children 12 months of age or younger. .0606(b) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. The medical report for M. Allison and H. Moody could not be located in their respective staff files. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. The TB Test or TB Screening for M. Allison could not be located in her file. .0701(a) 1908 A child's file did not have a statement with parent signature acknowledging receipt and explanation of the Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy and/or the acknowledgement did not have all the required information. One (1) child file did not have a signed and dated statement by parent that the policy was received and explained at enrollment in child’s file. .0608(b)(1-6) Technical assistance for correction plan: Monthly Playground Inspections *Playground inspections are required to be completed monthly. A plan must be provided to state how monthly playground inspections will be completed. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. Monthly Fire Drills *Fire drills are required to be practiced monthly and documented on the emergency drill log. A plan must be provided to state how monthly fire drills will be practiced and recorded. 10A NCAC 09 .0604 SAFETY REQUIREMENTS FOR CHILD CARE CENTERS (t) Fire drills shall be practiced monthly and records shall be maintained as required by 10A NCAC 09 .0302(d)(5). Safe Sleep ***Staff working in the infant classroom with children ages 12 months and younger must document sleep every 15 minutes to check for breathing, color, and sleep position. Documentation of sleep checks must be kept on file for at least one (1) month). The safe sleep policy must be posted in classrooms with children ages 12 months or younger. 10A NCAC 09 .0606 SAFE SLEEP PRACTICES (a) Each center licensed to care for infants aged 12 months or younger shall develop, adopt, and comply with a written safe sleep policy that: (6) specifies that caregivers shall visually check, in person, sleeping infants aged 12 months or younger at least every 15 minutes; (b) The center shall post a copy of its safe sleep policy about infant safe sleep practices in a prominent place in the infant room where parents and caregivers are able to view daily. (g) Documents that verify staff member's compliance with visual checks on infants shall be maintained for a minimum of one month. Activity Plans *A current activity plan must be posted. It is recommended to have activity plans completed and posted by the close of business on Fridays or at the opening of business on Mondays. 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. Staff/Child Ratio Charts *The staff/child ratios charts must be completed to show which staff/child ratio is applicable to each classroom. Check the appropriate box and fill in the top three lines at the top of the form. 10A NCAC 09 .2818 ENHANCED STAFF/CHILD RATIOS FOR A RATED LICENSE FOR CHILD CARE CENTERS (e) The staff/child ratio applicable to a classroom shall be posted in that classroom in an area that parents are able to view at all times. *The feeding plans must have a date received by the center and parent signature. 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. License Posted *The correct and current temporary license must be posted. § 110-99. Possession and display of license. (a1) Each child care facility shall display its current license in a prominent place at all times so that the public may be on notice that the facility is licensed and may observe any rating which may appear on the license. Any license issued to a child care facility under this Article shall remain the property of the State and may be removed by persons employed or designated by the Secretary in the event that the license is revoked or suspended, or in the event that the rating is changed. Safe Pick Up and Delivery Procedures *The safe pick up and delivery procedures must be posted to be visible to parents. 10A NCAC 09 .1003 SAFE PROCEDURES (b) Each center shall establish procedures for pick-up and delivery of children to ensure children are protected from danger and not exposed to risk of harm. These procedures shall be communicated to parents, and a copy shall be posted in the center where they can be seen by the parents. Prescription Medication Storage - Corrected During the Visit *Any prescription medication must be stored locked. The Nystatin was discarded during the visit since the child using the prescription was no longer enrolled at the facility. 15A NCAC 18A .2820 STORAGE (d) Medications including prescription and non-prescription items shall be stored in a locked cabinet or other locked container and shall not be stored above food. Designated emergency medications shall be kept inaccessible to children, but are not required to be in locked storage. Non-prescription diaper creams and sunscreen shall be kept inaccessible to children when not in use, but are not required to be in locked storage. Returning Medication or Discarding Medication – Corrected During the Visit *The Nystatin for the child that no longer attends at the facility was discarded. 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. Medication Authorization **Medication authorization is required to be on file for any medication administered to a child. The two diaper creams must be identified on the medication authorization form as well as the amount to be applied. The Tylenol and ibuprofen will need updated medication authorization forms. 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. (7) A parent may give a caregiver standing authorization for up to 12 months to apply over-the-counter, topical ointments, topical teething ointment or gel, insect repellents, lotions, creams, fluoridated toothpaste, and powders, such as sunscreen, diapering creams, baby lotion, and baby powder, to a child, when needed. The authorization shall be in writing and shall contain: (a) the child's name; (b) the names of the authorized ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (c) the criteria for the administration of the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders; (d) the manner in which the ointments, repellents, lotions, creams, fluoridated toothpaste, and powders shall be applied; (e) the signature of the parent; (f) the date the authorization was signed by the parent; and (g) the length of time the authorization is valid, if less than 12 months. Outdoor Equipment *The cap missing from the pole will need to be replaced. The crack in the climbing structure will need to be repaired or the pole will need to be replaced. We discussed having the children only use playground spaces #2 to make the equipment on playground space #3 inaccessible and the rust on playground space #1 to the children until repairs can be made. 10A NCAC 09 .0601 SAFE ENVIRONMENT (a) A safe indoor and outdoor environment shall be provided for the children in care in accordance with rules in this Section. (b) All equipment and furnishings shall be in good repair. All commercially manufactured equipment and furnishings shall be assembled and installed according to procedures specified by the manufacturer. For equipment and furnishings purchased after September 1, 2017, the manufacturer's instructions shall be kept on file or electronically accessible, if available. (c) Equipment and furnishings shall be sturdy, stable, and free of hazards that may injure children including sharp edges, lead based or peeling paint, rust, loose nails, splinters, protrusions (excluding nuts and bolts on sides of fences), and pinch and crush points. (d) All equipment and furnishings not meeting the requirements of Paragraphs (b) and (c) of this Rule shall be removed from the premises immediately or made inaccessible to the children. Outdoor Fences **All outdoor fences for the perimeter must be a minimum of four (4) feet in height. We discussed an estimate has been provided for new fencing. It is recommended to move forward with new fencing that is five (5) feet in height. We discussed a temporary solution of adding height to the fencing with lattice or another material while waiting on the fencing. The fence on playground space #2 will need to be repaired to close the gap between the fence and the ground to less than 3.5 inches. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (g) Any openings in equipment, steps, decks, handrails, and fencing shall be smaller than 3 ½ inches or greater than 9 inches to prevent entrapment. (i) The outdoor play area shall be protected by a fence. The height shall be a minimum of four feet and the top of the fence shall be free of protrusions. The requirement disallowing protrusions on the tops of fences shall not apply to fences six feet high or above. The fencing shall exclude fixed bodies of water such as ditches, quarries, canals, excavations, and fish ponds. Gates to the fenced outdoor play area shall remain closed while children occupy the area. Prevention of Shaken Baby Syndrome and Abusive Head Trauma Policy Acknowledgement *The acknowledgment must be signed by the parent and in the child file. 10A NCAC 09 .0608 PREVENTION OF SHAKEN BABY SYNDROME AND ABUSIVE HEAD TRAUMA (b) Within 30 days of adopting the policy, the child care center shall review the policy with parents of currently enrolled children up to five years of age. A copy of the policy shall be given and explained to the parents of newly enrolled children up to five years of age on or before the first day the child receives care at the center. The center shall obtain the parent’s signature on the statement acknowledging the receipt and explanation of the policy. The acknowledgement shall contain the following and be maintained in the child’s file for review by the Division: (1) The child’s name; (2) The date the child first attended the center; (3) The date the operator’s policy was given and explained to the parent; (4) The parent’s name; (5) The parent’s signature; and (6) The date the parent signed the acknowledgment. Staff Medical Report *The staff medical report must be on file prior to employment. Both M. Allison and H. Moody must have a staff medical report on file. A plan must be put in place for any future staff that will ensure the staff medical report is on file prior to employment. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: Child care providers and uncompensated providers who are not substitute providers or volunteers as defined in 10A NCAC 09 .0102, including the director. Item Requirements: Medical Report - A statement signed by a health care professional that indicates that the person is emotionally and physically fit to care for children. Due Date: Prior to employment - When submitted, the medical statement shall not be older than 12 months. Staff TB Test or TB Screening *The TB Test or TB Screening must be completed and on file on day one (1) of employment or before. M. Allison must have a negative TB Test or TB Screening on file. A plan must be put in place for any future staff that will ensure the TB Test or TB Screening is on file on day one of employment or before. 10A NCAC 09 .0701 HEALTH STANDARDS FOR CHILD CARE PROVIDERS, SUBSTITUTE PROVIDERS, VOLUNTEERS, AND UNCOMPENSATED PROVIDERS (a) Health and emergency information shall be obtained for staff members as specified in the chart below: Required for: All staff, including the director and individuals who volunteer more than once per week. Item Requirements: Tuberculin (TB) Test or Screening - The results indicating the individual is free of active tuberculosis shall be obtained within the 12 months prior to the date of employment. Due Date: On or before first day of work. 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 on or before 1/17/24. Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: monica.houck@dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education (DCDEE) Attn: Monica Houck PO Box 880, Fletcher, NC 28732 Please call me at 828-243-2154, or email monica.houck@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Rated License Assessment: Compliance History: The program must maintain a 75% or higher compliance history score to be eligible for a 2-5 star rated license. Staff Education: It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submitted an official transcript (if applicable) and applied for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. *Note - The facility may choose to use staff education points from the previous ownership. Program Standards: The Initial Application for a Two Component Star Rated License can be found on the Division’s website and the Rated License Request for Review form can be requested if you choose to apply for a two through five-star rated license and have the (ERS) assessment. *Note - The facility may choose to use program standard points from the previous ownership. Quality Point: A quality point has not been determined. *Note - The facility may choose to use the quality point from the previous ownership. Curriculum: All four and five star rated license facilities must implement an approved curriculum with four year-old children. Rated License Consultation: ITERS-R and ECERS-R A variety of different types of blocks such as wooden unit blocks, soft unit blocks, cardboard blocks, and homemade blocks with enough blocks in each set for at least three children to build a structure should be provided. The block center should be large enough for three children to build a substantial structure without interfering with one each other’s play. Art projects should allow individual expression by children. Copied, cookie cutter type art projects do not offer children an opportunity for individual expression. Allow children to choose the art media of their choice and provide a variety of materials. The following are suggestions for art materials: markers, chalk, colored pencils, paper, crayons, dry erase markers, finger paint, tape, glue, stickers, small pieces of paper, play dough, clay, hole punchers, stencils, stamps, and scissors. Children under three years age should not have access to materials that would be considered choking hazards such as foam items, small crayons, small pieces of chalk, plastic bags, items easily torn apart or that would fit in a choking tube. You can use these materials under direct teacher supervision working one on one with the child during the art activity. Display in the classroom should be primarily children’s work and not teacher or store-bought display. Children’s art should be posted on their eye level. Avoid long periods of waiting during transitions such as bathroom time or from one activity to another. Develop ideas and strategies to reduce waiting time for children. Teachers can sing songs and do finger plays with the children who are waiting. If children wait more than three minutes without activity, then you will be marked down on the ERS assessment score. Items such as puzzles and games that are missing pieces should be removed from the classroom and replaced. The classroom should have at least two books per child that are age appropriate for the children in the group. A variety of books that portray real animal pictures, families, disabilities and different cultures should be added to each classroom. Remove any books that are worn, torn or missing pages. Add pictures, books, puzzles, block play people, baby dolls, music, play food and dress-up clothes that represent different cultures. Add pictures, puzzles and block play people that represent people of all ages and disabilities. Water must be available to children throughout the day. Have a pitcher of water and cups for children available at all times. Tables must be cleaned with soapy water then wiped dry. Then spray table with the sanitizing solution and let it sit for at least two minutes before wiping dry. Follow this procedure before and after eating. Make sure no children are near the table when spraying the sanitizing solution. Sinks must be disinfected between changes of use. The staff should spray the sink with the disinfectant spray and allow the disinfectant to stay for at least two minutes before turning on the water and using the sink. All children must have their diapers or pull ups checked or changed at least every two hours and when soiled. Use a timer or follow a daily individual diaper changing schedule to keep you within the two-hour timeframe. Children must wash their hands upon arrival, before and after eating, before and after sand and water play, after toileting, after outdoor play, after handling messy art materials such as paint, glue, and playdough and after touching nose, mouth, floor, trashcan, and anything else that re-contaminates the hands. Staff should follow proper handwashing procedures and wash hands as required. Remove mouthed items from play immediately and sanitize before allowing other children to play with item. You must interact with children in relation to their play with materials. At least two instances must be observed. Math/number - One instance must be observed during routine care as well as during free play of using math/number. It is recommended that you visit www.ncrlap.org for supplemental materials for preparing for the Environment Rating Scale Assessments. Additional notes to the Early Childhood Environment Rating Scale Revised Edition can be obtained on this website. NCRLAP also offers the Outreach Assessment and Webinar trainings for staff. I also recommended that you register staff now for the upcoming Webinar trainings listed on the ncrlap.org website. Contact your local Child Care Resource and Referral office for further technical assistance with the Environment Rating Scales. Child Care Resource and Referral (CCR&R) Agency – Southwestern Child Development Commission, Inc. - Gail Mattingly, 828-354-0361, Mattingly.Gail@swcdcinc.org Consultation: The rated license dated 1/14/23, from the previous ownership, was not on-site to collect. Continue to keep the staff and training worksheet updated as changes occur. Anytime staff changes occur, plan to update the Emergency Medical Care (EMC) plan to reflect the changes. We discussed the EMC plan needs to be updated. The EMC plan must be updated at least annually if no changes during the year and posted to be easily viewed. Reminder that immunization and children’s medical reports are due within 30 days of enrollment. We discussed that you will need to discuss with Clay County Environmental Health to determine if the Lysol Disinfectant wipes are an approved disinfectant that can be stored at five feet or if the wipes need to be locked. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact the child care consultant within thirty (30) days prior to the change. Failure to notify the child care consultant, may result in a violation of child care requirements. Compliance History Score Any observed violations cited during visits will negatively affect the center's Compliance History Score. Your program must maintain a compliance score of at least 75% as required by G.S. 110-90 (4)(c). Health and Safety Training It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you as needed. The North Carolina Early Childhood Equivalency Exam is now available on DCDEE Moodle. Visit the Division’s website to find out more information. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at monica.houck@dhhs.nc.gov or 828.243.2154, or my supervisor, Bonnie Mathis at bonnie.mathis@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times
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