NC GS 110-90 · Violation

Name of Operation: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 10/27/2025 Number Present: 17 Completed Date: 10/27/2025 Age: From 1 To 5 Total Minutes: 390 Time In: 09:00 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements and provide technical assistance on the QRIS rules in Section .3200. Last Annual Compliance visit – 11/20/24 18-month compliance history from 4/25/24 – 10/24/25 = 88% Last Sanitation Inspection – 10/9/25 - Superior Water Testing (Lead) – completed 8/16/24; due again 8/16/27 Last Fire Inspection – 9/24/25 – Satisfactory; Daytime Care Only *Sanitation and fire inspections are required at least annually by the end of the month of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. E. Oppong, Administrator, was present and assisted me with the visit. The facility currently operates with a Three-Star Center License, initially issued 8/6/21 and issued 8/25/25 (age range change) and is due to be reassessed and processed by 12/31/26. The Child Care Commission adopted the QRIS Modernization rules (Pathways to Stars), and the Division is moving forward with using the new QRIS rules found in Section .3200 of the NC Child Care Requirements to assess rated licenses. See QRIS Technical Assistance for more information about the transition. Note that the current program assessment tool is changing from the Early Childhood Environment Rating Scale – Revised (ECERS-R) to the Early Childhood Environment Rating Scale – 3 (ECERS-3) and the ITERS-R to the ITERS-3. Information and training on the new program assessment tool is available on the NC Rating License Assessment Project website at https://ncrlap.org/. This facility is owned by Healthy Environments Child Development Center KDHNC, LLC. According to the NC Secretary of State's website, this limited liability corporation is current and active as of 10/24/25. License and contact information were current. Please contact me prior to any information change regarding the ownership of this facility, license updates, or contact information (address, phone, or email). I monitored the classrooms and spaces used for child care and outdoor play areas for applicable child care center requirements using the Child Care Center Requirements, effective 7/1/2025 and Item Numbers Listing, effective 4/2025. I monitored one staff record, two children’s records and all program records. The facility does not offer transportation. Center Observations: I completed a walk-through of the facility and monitored all indoor and outdoor spaces. I observed children participating in routines and developmentally appropriate activities both indoors and outdoors. Staff/child ratios and supervision were in compliance. The children, one and two years of age, in Space 5 were in free play and then had a story read to them. When one child did not want to sit for the story, he was allowed to continue to play with Duplos. Five children, three through five years of age, from Space 3 were combined with six children, two years of age, in Space 2 were engaged in a short group time before transitioning to indoor free play. When additional children arrived, the administrator worked in the classroom to maintain staff/child ratios and supervision. A part-time substitute arrived later to assist in classrooms. Later everyone went outdoors. The toddlers played on the small playground while the preschool-age children played on the larger playground. Lunches were brought from home, were labeled, and dated. After lunch, children rested linen-covered cots. Children and staff washed hands as required. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 714 Openings in equipment, steps, decks, handrails, and fencing were not less than 3 1/2 inches or greater than 9 inches. On the fence separating the two playgrounds, a vertical slat was missing, creating an opening that measured 4.5 inches. .0605(g) 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. Four “correction pens” were stored in a red basket out of reach of children on top of the blue armoire in the office area. The warning labels included “Caution: flammable. Keep away from children. Do not swallow or inhale.” .2820(b) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to you, E. Oppong. We reviewed the visit summary and the two violations documented during today’s visit. You corrected one (storage of hazardous items) during the visit. Correct the violation related to the missing fence slat immediately. Send evidence of correction to me so that I receive it no later than 11/10/25. Your compliance verification letter needs to state your facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. Do not include names of children in the compliance letter. Use their initials. Also include the following documents/pictures to verify compliance: picture of fence with replaced slat and opening no greater than 3.5 inches. Send compliance verification letter in an email from your center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. You may include the compliance verification as an attachment or in the body of the email. I will email a sample compliance verification letter to you. If sufficient information is not received by the due date, a follow-up visit may be conducted. Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199. Technical Assistance With Documented Violations: Entrapment Areas – Openings in outdoor equipment or between the slats on fences need to be less than 3.5 inches or greater than 9 inches to prevent children from becoming entrapped or stuck in the fence or equipment. An opening in the fence between the toddler and preschool playgrounds is about 4.5 inches wide, creating a possible entrapment area. You stated that you had repaired the fence with two vertical slats, but one of them must have come loose and been removed. You will add another slat to the fence to make the opening < 3.5 inches. You also showed me a space in the vertical slats on the ramp that needs to be fixed. That opening is > 9 inches so is not an entrapment area but needs to be fixed to keep smaller children from going through it to reach a part of the outdoor area that is not used by children. For your compliance letter, state the date when you have repaired the opening in the fence between the two playgrounds and include a picture. Storage of Hazardous Items - There are over two million human poison exposures reported to poison centers every year. Children under six years of age account for over half of those potential poisonings. The substances most involved in poison exposures of children are cosmetics and personal care products, cleaning substances, and medications. Four “correction pens” were stored in a red basket out of reach of children on top of the blue armoire in the office area. The warning label included “Caution: flammable. Keep away from children. Do not swallow or inhale.” You stated that teachers moved these out of reach but did not realize that they needed to be locked. Items with additional warning labels other than “Keep out of reach of children”, including some personal care items, all cleaning supplies, and anything in an aerosol can are required to be locked. Acceptable locks include magnetic safety locks, locks requiring a key, combination locks, and padlocks. Child-safety latches are not acceptable to prevent access. For more details on hazardous materials storage, look at 15A NCAC 18A .2820 in the NC Environmental Health Requirements. You corrected this during the visit, so no further action is required except to ensure that hazardous items are locked. General Visit Information: As a licensed child care facility, it is your responsibility to be knowledgeable of the child care laws and rules and to teach your staff the rules to ensure your center remains in compliance. The most recent versions of laws and rules regarding child care facilities in North Carolina are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. You can also review the “What’s New” section and download a copy of the Items Number Listing which you can use as a checklist for your program. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies and Child Care Health Consultants provide general training to meet on-going training hours, health and safety training requirements, Environment Rating Scale training and training specific to your center’s needs. They can also work with you to provide on-site technical assistance. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone – (252) 333-1233; website - www.aacfnc.org . *Healthy Behaviors Specialist: P. White – Phone (252) 333-1233; pam@aacfnc.org *The North Carolina Rated License Assessment Project (NCRLAP), www.ncrlap.org , has resources to help you and your staff prepare for the third editions of the Environment Rating Scales (ECERS-3 and ITERS-3). Visit the website for more information about updated resources, credit hour trainings, self-assessments and outreach assessment opportunities to help you become familiar with these tools. At this time the SACERS-U will continue to be the program assessment tool for school-age programs and classrooms. *Southwestern Child Development Commission, www.swcdcinc.org, Child Care Resources Inc., https://www.childcareresourcesinc.org/ and Early Years, https://www.earlyyearsnc.org/ offer DCDEE approved, on-line, self-paced and virtual real-time training and CEUs. SWCDC also offers affordable annual packages allowing you to take as many courses as you need or want for one price. The Natural Learning Initiative (https://naturalearning.org/) offers a variety of resources such as training, YouTube videos, handouts, etc. to help you add natural elements to your outdoor play spaces to promote time outdoors. Check out the NLI Resource Hub including Design Sites, Infosheets, The Green Desk, Interactive Apps and more! Your children and your teachers will want to go outdoors again! Reminders: Children’s Records – Your “All About Me” page in your children’s files provides a lot of helpful information about each child. Make sure your staff get to see that form so that they can learn more about the children in their groups. ABCMS Portal – Thank you for connecting your staff to your license number and hiring them to your roster! Maintain your roster by adding new staff within five days of hire and removing staff when they are no longer employed with you. Staff Worksheets – We reviewed your staff worksheet. I highlighted items that are coming due in the next year. *Health and Safety Training and Five (5) Year Cycle Tracking Requirements – current for all staff *On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours returning staff will need by 10/27/26 anniversary of today’s Annual Compliance visit). Staff Education and Works – When K. Pegues completes EDU 119 or any staff complete additional education, have them request an official, original transcript and complete their Works registration. Mail an unopened copy to DCDEE or request that a hard copy or electronic copy be sent from COA to DCDEE. Request to be approved for their desired positions in the upper left corner of the screen. Incident Reports – Incident Reports keep parents informed of injuries their child has at your facility and provide an opportunity for you and your staff to review your own safety and supervision practices to prevent similar injuries in the future. If a child is injured while attending child care and the injury requires minor on-site first aid (band-aid, ice pack, tweezers, etc.) or professional medical care (doctor, hospital, EMS, etc.), complete an Incident Report (updated 3/2021) with help from the staff members who witnessed the accident and provided first aid. Review with the parent and have her/him sign. The parent must be offered a copy but may choose to decline a copy by checking and initially the box at the bottom. The original copy is maintained in the child’s file and documented on the Incident Log. If the injury requires professional medical attention, mail a copy of the Incident Report to the child care consultant within seven days. *You have a separate file for Incident Reports. These need to be added to the child’s file. Document Incident Reports on one center-wide Incident Log. Administrator Requirements – If an administrator meets preservice requirements but does not have the NC Early Childhood Administrative Credential (NCECAC) when hired or promoted into the position, they have six months to enroll in the coursework needed (EDU 261 and 262) and two years to finish from the start of the course. Lead Teacher Requirements – Lead Teachers who do not have the NC Early Childhood Credential (NCECC) or higher or an equivalent have six months to enroll in coursework that will lead to the NCECC (EDU 119 at the local community college) and eighteen months to complete it after enrollment. To remain qualified for a Lead Teacher position, K. Pegues needs to enroll in EDU 119 by April 2026; but until completed, she will remain at the 1-Star level for education. Completing EDU 119 with eventually five years of experience will increase her to the 3-Star level. *Session Law 2025-36 added another option to be qualified as a lead teacher – have a minimum of five years of documented experience teaching in a licensed child care facility in North Carolina which shall be deemed equivalent to the North Carolina Early Childhood Credential. Staff who choose to meet the lead teacher qualifications through five years of NC child care experience will register for Works and upload a copy of their resume with information about their experience in North Carolina child care facilities. This will achieve the minimum requirements for lead teacher at the 1-Star level. Additional options will need to be met to earn the 2-Star level or higher. Required Beverages – Offering children appropriate beverages helps them to ingest nutrients that will build brain and physical development. Water is essential for bodily functions like temperature regulation, nutrient transport, waste removal, and lubricating joints. Meals and snacks are brought from home, but if you offer milk for children between 12 months and 24 months of age, it needs to be whole milk. Skim or 1% milk may be served to children older than 24 months of age. Emergency Preparedness – Your Emergency Preparedness and Response Plan (EPR Plan) along with your Ready-to-Go File, Emergency Medical Care Plan (EMCP) and consistent practice of Fire and Emergency Drills are your center’s foundation for emergency preparedness. *Review your EPR Plan at least annually in the NC Risk Management Portal and update, if needed. Print updated plan or updated cover sheet and page 28. If there are no changes, update the information on Page 28 and print that page and the cover sheet which should reflect the revised date. (I can email instructions on how to update your EPR Plan, if needed.) *At the same time, review and update your Emergency Medical Care Plan, if needed. *Ensure your Ready-to-Go File is current and includes the following: a copy of the Emergency Preparedness and Response Plan, child's Application for Child Care (includes health & emergency information, contacts, authorization to seek emergency medical care), medication authorizations and instructions, any action plans for children with special health care needs, a list of any known food allergies of children and staff, staff contact information, Incident Report forms, an area map (add an area map to your Ready-to-Go File), and emergency telephone numbers. *EPR Plan – initially created 12/13/24; update in December 2025 *Ready-to-Go File – current; stored on top of blue armoire in office; add an area map *Emergency Medical Care Plan – current. *Fire and Emergency Drills - current Activity Plans – Activity Plans must be current, dated and posted where they are easily visible and include daily activities that meet the five developmental goals in the NC Foundations for Early Learning and Development. Additional Comments: Annual Licensing Fee - Keep an eye on your email inbox for the 2025 Annual License Fee invoice. Invoices will be emailed to the facility email address by November 3, 2025. Since the invoice number changes each year, you will need to ensure the invoice number you are paying begins with 25. Online payments are due by December 3, 2025. License fees are paid online only, and paper checks are not accepted for payment. Licensed child care facilities are assessed an annual license fee. The amount of your annual license fee is based on the licensed capacity printed on your license as of October 1, 2025, not the number of children enrolled at your facility. Please note that annual license fees do not apply to state or public school-operated child care facilities, or to religious-sponsored facilities operating under a Notice of Compliance. For questions regarding license fees, visit the License Fee Frequently Asked Questions (FAQs en español) or email DCDEE_LF@dhhs.nc.gov for further assistance Raise NC Newsletter – If you are not receiving and reading the Raise NC Newsletter, you are missing out on current relevant information about early childhood issues in North Carolina, information about proposed rules, available trainings and other information that may be of interest to you and your staff. The Raise NC Newsletter is typically sent out weekly to all facility contact email addresses, but if your email is not the facility contact email address, you can go to the DCDEE Website, https://ncchildcare.ncdhhs.gov/ and click on the “What’s New” tab. Click on “What’s New” and enter your email address and name under “Sign Up for Updates”. As an early learning professional, you need to stay in the know about issues in North Carolina that affect you and your business. Share with your staff so they can be in the know too! Keep Your NCID Active - Did you know that if you do not login on to any DCDEE platforms (e.g., Moodle, WORKS, CBC) for a period of 12 months, your account will be archived? An archived account cannot be reinstated. You will need to create a new one and then email all platforms (e.g., Moodle, WORKS, CBC) to merge accounts. *Pro Tip: Set your calendar to remind you, your staff and your household members (CLIAR only) every 6 months to log in and out at https://myncid.nc.gov to keep your account activated and it will NOT be archived. *For assistance with NCID, contact ncid.nc.gov or 919.754.6000. Sex Offender Registry and Notification Email - North Carolina General Statute 14-208 requires sex offenders to register with the North Carolina Department of Justice. The law states that a sex offender shall not knowingly reside within 1,000 feet of the property on which any public or nonpublic school or child care center is located. This does not apply to child care centers that are located on or within 1,000 feet of property of an institution of higher education where the registrant is a student or is employed. All licensed child care centers must register to receive e-mail notification when a registered sex offender moves within a one-mile radius of the center. (§14-208.19) To register for the e-mail notification, go to http://sexoffender.ncsbi.gov. If you have any questions, please contact your local sheriff's department. QRIS (Quality Rating Improvement System) Technical Assistance: Elizabeth Oppong, Owner/Administrator and I discussed the facility’s plan for completing a rated license assessment using the new QRIS rules found in Section .3200 of the NC Child Care Rules. All information on the QRIS rated license assessments and documents will be posted at https://ncchildcare.ncdhhs.gov/Provider/Licensing/Star-Rated-License/QRIS-Modernization and will also be provided through emails and Raise NC newsletters. During the visit we completed the QRIS Conversation Template with a focus on the selected pathway. Pathway 2: Classroom and Instructional Quality We reviewed current staff education to determine the facility’s expected star level based on education is 2 Stars. When KP completes EDU 119 and it is posted on Works, her education star level will increase from 1 Star to 3 Stars. When TP has 3 years of experience, she will increase from 2 Stars to 3 Stars. When KP completes an additional 6 semester hours or has 3 years of experience, she will increase from 2 Stars to 3 Stars. We walked through the Individual and Facility CQI forms. The Individual CQI form must be completed and reviewed annually by all staff (Administrator, Lead Teachers, Teachers). This form will replace the Professional Development Plan. The Facility CQI form will be completed annually by the Administrator to set overall goals for the center. The administrator will also complete the Family and Community Engagement Plan. She checked items that are already met and those that they feel they can meet. Consider keeping a Family and Community Engagement Plan notebook or file to maintain documents that verify the foundational and optional practices are met. You have had success with using the Abeka Curriculum at your center in Virginia and are interested in bringing it to your center here. Currently it is not approved which will limit you to the 3-Star level. The administrator and lead teachers will need to provide verification that they have received training on the selected curriculum and formative assessment tool. The publisher is invited to submit it for review to have it approved. When you implement it, you and the lead teachers need to have training on implementing Abeka. It needs to include all ages, one – five years of age. At the 3-Star Level you do not have to use an approved formative assessment, but teachers will need to make and document observations with the children. The curriculum you use may have an observation tool. We discussed options for five hours of additional training (on-going training or CEUs) or coaching for the administrator. We completed the QRIS Conversation Template reviewing documents and resources available to you and you listed the areas where you feel you need support. Submit any education needed to be assessed to DCDEE Works by June 2025. Action Items: 1. Once you select your curriculum and formative assessment, each Lead Teacher and the Administrator need to complete training on the curriculum. 2. Create your plan for lead teachers and administrators to complete one of the following activities regarding classroom and instructional quality practices: either 5 hours of coaching/mentoring OR 5 additional on-going training hours OR .5 additional CEUs. 3. Each administrator and staff member will complete an individual Continuous Quality Improvement Plan (CQI Plan) annually that will be reviewed and updated annually. (Doubles as Annual Professional Development Plan.) The administrator will also complete a Center Continuous Quality Improvement Plan. 4. Facility will complete Family and Community Engagement Plan and provide documentation that they are meeting the foundational practices and at least two of the optional practices – one from two of the three categories. Your rated license assessment is currently due by 12/31/2026 but you are going to complete it when your staff education and curriculum requirements are met. Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 4/23/2025 Number Present: 23 Completed Date: 4/23/2025 Age: From 1 To 5 Total Minutes: 240 Time In: 09:00 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced * The purpose of today’s Routine Unannounced visit was to monitor compliance with applicable child care requirements. Last Annual Compliance visit – 11/20/24 18-month compliance history from 10/18/23– 4/17/25 = 84% Last Sanitation Inspection – 3/7/25 - Superior Last Fire Inspection – 10/18/24 –Passed *Sanitation and fire inspections are required at least annually by the end of the month of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. S. Morris, Site Manager, and E. Oppong, Administrator, were present and assisted me with the visit. The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/21, but legislation (Senate Bill 425) has extended the “hold harmless” period until the new Quality Rating Improvement System (QRIS) is implemented. At this time, you may choose to complete a rated license assessment using the current rated license process or you may wait until the new QRIS is implemented. The proposed QRIS Modernization rules have been published and are pending adoption. Note that the current program assessment tool is changing from the Early Childhood Environment Rating Scale – Revised (ECERS-R) to the Early Childhood Environment Rating Scale – 3 (ECERS-3) and from the Infant/Toddler Environment Rating Scale – Revised (ECERS-R) to the ITERS-3. Information and training on the new program assessment tool is available on the NC Rated License Assessment Project website at https://ncrlap.org/. This facility is owned by Healthy Environments Child Development Center KDHNC, LLC. According to the NC Secretary of State's website, this limited liability corporation is current and active as of 4/22/25. You are in the process of making some changes to your LLC that do not constitute an ownership change; I have provided you with paperwork to complete so information related to your LLC can be updated. Please contact me prior to any information change regarding the ownership of this facility. License information was current. You no longer care for infants. You are going to make a request to change your age range from 0 – 12 years to 1 to 6 years. Send an email with that request, and I will process a new license to reflect the change. You updated your personal phone number. Other contact and license information were the same. Contact me to make any changes to address, phone, or email or to request changes to the license. I monitored the classrooms and spaces used for child care and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 11/1/2024 and Item Numbers Listing, effective 4/2025. There were no new staff, so I did not monitor staff or children’s records. I monitored all program records. The facility does not offer transportation. Center Observations: Twenty-three children, one through five years of age, were present in four classrooms. All groups participated in circle time, indoor free play, and outdoor free play. It was an especially beautiful spring day, and the older groups played outside a little longer to take advantage of the nice weather with no mosquitoes. They rode tricycles on the bike path, played with portable gross motor materials and played make believe. They washed hands when they returned inside to prepare for lunch. Lunches are brought from home. Parents sign Nutrition Opt-out forms. After lunch, they rested on linen-covered cots while quiet music was played throughout the center. I observed and documented the following violation during today’s visit. It was corrected during the visit. Violation Number Comment Rule 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In Space 5, a tub of Vaseline used for diaper changing was not accompanied by a blanket medication permission form. 10A NCAC 09 .0803(1)(a & b) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to you, E. Oppong. We reviewed the visit summary and violation documented during today’s visit. You corrected the violation today and returned the topical ointment to the parent. No further action is needed at this time. Remind staff not to accept medication. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199. Technical Assistance with Documented Violation: Medication Permission Forms - All medications (prescription, OTC, non-medicated topical ointment, lotion, or cream) for children enrolled at the center must have a current, completed medication permission form to ensure that staff are administering medication according to the parents’ or physician’s instructions. A child in Space 5 had a tub of Vaseline for diaper changes, but there was no medication permission form. The administrator stated that because it was not diapering cream and was only Vaseline, she did not think a medication permission form was needed. Blanket medication permission forms for non-medicated topical ointments or creams, e.g., diaper cream, lotion, sunscreen, teething gel, are valid for one year and do not require an administration log. (OTC medications and prescription medications require a detailed medication permission form and require documentation when the medication is administered.) You removed the medication and returned it to the parent. You stated that for now, you will only accept emergency medications such as inhalers, epi-pens, and anti-seizure medication. This violation has been corrected. *I also observed an Auvi-Q for a child with food allergies. The permission form was completed correctly. This type of medication form is valid for six months. Consider having this type of medication form updated in January and July. General Visit Information: As a licensed child care facility, it is your responsibility to be knowledgeable of the child care laws and rules and to teach your staff the rules to ensure your center remains in compliance. The most recent versions of laws and rules regarding child care facilities in North Carolina are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. You can also review the “What’s New” section and download a copy of the Items Number Listing which you can use as a checklist for your program. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies and Child Care Health Consultants provide general training to meet on-going training hours, health and safety training requirements, Environment Rating Scale training and training specific to your center’s needs. They can also work with you to provide on-site technical assistance. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone – (252) 333-1233; website - www.aacfnc.org . *Healthy Behaviors Specialist: P. White – Phone (252) 333-1233; pam@aacfnc.org *Birth – 3 Quality Specialist: J. Davidson – Phone (252) 333-1233; joy@aacfnc.org *Southwestern Child Development Commission, www.swcdcinc.org - offers DCDEE approved, on-line, self-paced training with affordable annual packages allowing you to take as many courses as you need or want for one price. *NC Health and Safety Resource Center, https://healthychildcare.unc.edu/ - has trainers approved to offer Medication Administration, ITS/SIDS, Emergency Preparedness and Response, and required Health & Safety Trainings (in-person) and more. They also publish a quarterly E-Newsletter with an array of topics to help you provide a healthy and safe early learning and out of school environment. *So glad to see that you are reaching out to use your resources. S. Rosser is providing technical assistance with health and safety topics such as diaper changing, handwashing and sanitation procedures. J. Davidson is offering technical assistance with the ITERS-3. Reminders: ABCMS Portal - The process of notifying the Division when you have new staff (has changed and is now captured in ABCMS, the new Criminal Background Check portal. You have completed the ABCMS Provider Portal Training and are now authorized to log in the ABCMS Provider Portal https://ncabcms.nc.gov/DCDEE/ using your Business NCID. You stated that you have accessed the portal and are working on connecting applications but are finding it confusing. If you need assistance using the ABCMS Provider Portal, contact the Criminal Background Check Unit at (919) 814-6401 or DCDEE_ABCMS_Provider@dhhs.nc.gov and someone will assist you. Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. Make it easier on yourself and schedule annual updates for staff evaluations and professional development plans; health questionnaires and emergency information forms; EPR Plan and Emergency Medical Care Plan at the same time to streamline your staff updates. (Example, even if an employee was hired in January, and you update health questionnaires and emergency forms in August, have this employee go ahead and update in August with the rest of the staff to jump into the same cycle!) *A few staff are scheduled to update their Health Questionnaires and Staff Emergency Information Forms in April/May. 2025. Consider completing these tasks for all staff to streamline the process. *A few staff are scheduled to update their Annual Evaluations and Professional Development Plans in May/June 2025. Consider completing these tasks for all staff to streamline the process. *Your EPR Plan was scheduled to be reviewed and updated, as needed, in January 2025. A good time to review that with staff would February each year. On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours returning staff will need by 11/20/25 (anniversary of last Annual Compliance visit). *ECE college coursework or coursework leading to an ECE degree counts towards on-going training hours. Each semester credit counts as 16 hours so a 3-credit classes also earns 48 hours of on-going training. *Check with your local Child Care Resource & Referral for available training. *Training available on Moodle *The following offer on-line training opportunities at reasonable prices and accessible at times for your busy schedules: Southwestern Child Development Commission, www.swcdcinc.org – offers individual and group packages also ProSolutions courses are still available for a fee – offers individual and group packages also *Use the On-going Training Log to document training annually. Attach copies of certificates. Staff Education and Works – Once they complete EDU 119, T. Peterson and K. Petersen need to request an official, original transcript and complete their Works registration. They will need to mail an unopened copy to DCDEE or request that a hard copy or electronic copy be sent from COA to DCDEE. They need to register for Works or complete their Works accounts. Playground – It’s Spring! Be sure to keep the Virginia Creeper cut back off the fence. It’s not as toxic as Poison Ivy but can cause skin irritations. Plastic Bags – Plastic bags, even those used to store children’s clothing, has to be stored five feet or higher in classrooms with children younger than three years of age. Activity Centers – Your activity centers are coming together. Group like items together. All blocks and accessories need to be stored in the block center. Dramatic play materials need to be stored in the dramatic play center. In some cases, less is more. Don’t crowd the shelves. Add picture labels with words to children can easily identify where materials belong. The two preschool classrooms need more work on their activity centers. The following activity centers are required: art, blocks, books, dramatic play, and manipulatives. These materials need to be accessible daily. Science/nature, music and movement, and sand and water need to be offered weekly. Add a sandbox and water table outdoors. You are working with J. Davidson on the ERS. She can provide you with materials listings to provide the quantity and variety of materials for each center. Additional Comments: Raise NC Newsletter – If you are not receiving and reading the Raise NC Newsletter, you are missing out on current relevant information about early childhood issues in North Carolina, information about proposed rules, available trainings and other information that may be of interest to you. The Raise NC Newsletter is typically sent out weekly to all facility contact email addresses, but if your email is not the facility contact email address, you can go to the DCDEE Website, https://ncchildcare.ncdhhs.gov/ and click on the “What’s New” tab. Click on “What’s New” and enter your email address and name under “Sign Up for Updates”. As an early learning professional, you need to stay in the know about issues in North Carolina that affect you and your business. Share with your staff so they can be in the know too! I shared information on the following topics and emailed the information to you after the visit: 1. NCAEYC Advocacy Circle: A Space to Be Heard 2. Register Now for Impact Summitt – Saturday, 6/7/25 3. Important! NCID Password Rule Changing and Tips to Keep NCID Updated 4. Update on QRIS Modernization – Proposed Rules pending adoption 5. Moodle Helpful Hints 6. Environment Rating Scales – Get Ready for the 3’s! Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 4/23/2025 Number Present: 23 Completed Date: 4/23/2025 Age: From 1 To 5 Total Minutes: 240 Time In: 09:00 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced * The purpose of today’s Routine Unannounced visit was to monitor compliance with applicable child care requirements. Last Annual Compliance visit – 11/20/24 18-month compliance history from 10/18/23– 4/17/25 = 84% Last Sanitation Inspection – 3/7/25 - Superior Last Fire Inspection – 10/18/24 –Passed *Sanitation and fire inspections are required at least annually by the end of the month of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. S. Morris, Site Manager, and E. Oppong, Administrator, were present and assisted me with the visit. The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/21, but legislation (Senate Bill 425) has extended the “hold harmless” period until the new Quality Rating Improvement System (QRIS) is implemented. At this time, you may choose to complete a rated license assessment using the current rated license process or you may wait until the new QRIS is implemented. The proposed QRIS Modernization rules have been published and are pending adoption. Note that the current program assessment tool is changing from the Early Childhood Environment Rating Scale – Revised (ECERS-R) to the Early Childhood Environment Rating Scale – 3 (ECERS-3) and from the Infant/Toddler Environment Rating Scale – Revised (ECERS-R) to the ITERS-3. Information and training on the new program assessment tool is available on the NC Rated License Assessment Project website at https://ncrlap.org/. This facility is owned by Healthy Environments Child Development Center KDHNC, LLC. According to the NC Secretary of State's website, this limited liability corporation is current and active as of 4/22/25. You are in the process of making some changes to your LLC that do not constitute an ownership change; I have provided you with paperwork to complete so information related to your LLC can be updated. Please contact me prior to any information change regarding the ownership of this facility. License information was current. You no longer care for infants. You are going to make a request to change your age range from 0 – 12 years to 1 to 6 years. Send an email with that request, and I will process a new license to reflect the change. You updated your personal phone number. Other contact and license information were the same. Contact me to make any changes to address, phone, or email or to request changes to the license. I monitored the classrooms and spaces used for child care and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 11/1/2024 and Item Numbers Listing, effective 4/2025. There were no new staff, so I did not monitor staff or children’s records. I monitored all program records. The facility does not offer transportation. Center Observations: Twenty-three children, one through five years of age, were present in four classrooms. All groups participated in circle time, indoor free play, and outdoor free play. It was an especially beautiful spring day, and the older groups played outside a little longer to take advantage of the nice weather with no mosquitoes. They rode tricycles on the bike path, played with portable gross motor materials and played make believe. They washed hands when they returned inside to prepare for lunch. Lunches are brought from home. Parents sign Nutrition Opt-out forms. After lunch, they rested on linen-covered cots while quiet music was played throughout the center. I observed and documented the following violation during today’s visit. It was corrected during the visit. Violation Number Comment Rule 842 A drug or medication was administered without written authorization and/or instructions from a child's parent or authorized health professional. In Space 5, a tub of Vaseline used for diaper changing was not accompanied by a blanket medication permission form. 10A NCAC 09 .0803(1)(a & b) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to you, E. Oppong. We reviewed the visit summary and violation documented during today’s visit. You corrected the violation today and returned the topical ointment to the parent. No further action is needed at this time. Remind staff not to accept medication. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199. Technical Assistance with Documented Violation: Medication Permission Forms - All medications (prescription, OTC, non-medicated topical ointment, lotion, or cream) for children enrolled at the center must have a current, completed medication permission form to ensure that staff are administering medication according to the parents’ or physician’s instructions. A child in Space 5 had a tub of Vaseline for diaper changes, but there was no medication permission form. The administrator stated that because it was not diapering cream and was only Vaseline, she did not think a medication permission form was needed. Blanket medication permission forms for non-medicated topical ointments or creams, e.g., diaper cream, lotion, sunscreen, teething gel, are valid for one year and do not require an administration log. (OTC medications and prescription medications require a detailed medication permission form and require documentation when the medication is administered.) You removed the medication and returned it to the parent. You stated that for now, you will only accept emergency medications such as inhalers, epi-pens, and anti-seizure medication. This violation has been corrected. *I also observed an Auvi-Q for a child with food allergies. The permission form was completed correctly. This type of medication form is valid for six months. Consider having this type of medication form updated in January and July. General Visit Information: As a licensed child care facility, it is your responsibility to be knowledgeable of the child care laws and rules and to teach your staff the rules to ensure your center remains in compliance. The most recent versions of laws and rules regarding child care facilities in North Carolina are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. You can also review the “What’s New” section and download a copy of the Items Number Listing which you can use as a checklist for your program. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies and Child Care Health Consultants provide general training to meet on-going training hours, health and safety training requirements, Environment Rating Scale training and training specific to your center’s needs. They can also work with you to provide on-site technical assistance. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone – (252) 333-1233; website - www.aacfnc.org . *Healthy Behaviors Specialist: P. White – Phone (252) 333-1233; pam@aacfnc.org *Birth – 3 Quality Specialist: J. Davidson – Phone (252) 333-1233; joy@aacfnc.org *Southwestern Child Development Commission, www.swcdcinc.org - offers DCDEE approved, on-line, self-paced training with affordable annual packages allowing you to take as many courses as you need or want for one price. *NC Health and Safety Resource Center, https://healthychildcare.unc.edu/ - has trainers approved to offer Medication Administration, ITS/SIDS, Emergency Preparedness and Response, and required Health & Safety Trainings (in-person) and more. They also publish a quarterly E-Newsletter with an array of topics to help you provide a healthy and safe early learning and out of school environment. *So glad to see that you are reaching out to use your resources. S. Rosser is providing technical assistance with health and safety topics such as diaper changing, handwashing and sanitation procedures. J. Davidson is offering technical assistance with the ITERS-3. Reminders: ABCMS Portal - The process of notifying the Division when you have new staff (has changed and is now captured in ABCMS, the new Criminal Background Check portal. You have completed the ABCMS Provider Portal Training and are now authorized to log in the ABCMS Provider Portal https://ncabcms.nc.gov/DCDEE/ using your Business NCID. You stated that you have accessed the portal and are working on connecting applications but are finding it confusing. If you need assistance using the ABCMS Provider Portal, contact the Criminal Background Check Unit at (919) 814-6401 or DCDEE_ABCMS_Provider@dhhs.nc.gov and someone will assist you. Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. Make it easier on yourself and schedule annual updates for staff evaluations and professional development plans; health questionnaires and emergency information forms; EPR Plan and Emergency Medical Care Plan at the same time to streamline your staff updates. (Example, even if an employee was hired in January, and you update health questionnaires and emergency forms in August, have this employee go ahead and update in August with the rest of the staff to jump into the same cycle!) *A few staff are scheduled to update their Health Questionnaires and Staff Emergency Information Forms in April/May. 2025. Consider completing these tasks for all staff to streamline the process. *A few staff are scheduled to update their Annual Evaluations and Professional Development Plans in May/June 2025. Consider completing these tasks for all staff to streamline the process. *Your EPR Plan was scheduled to be reviewed and updated, as needed, in January 2025. A good time to review that with staff would February each year. On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours returning staff will need by 11/20/25 (anniversary of last Annual Compliance visit). *ECE college coursework or coursework leading to an ECE degree counts towards on-going training hours. Each semester credit counts as 16 hours so a 3-credit classes also earns 48 hours of on-going training. *Check with your local Child Care Resource & Referral for available training. *Training available on Moodle *The following offer on-line training opportunities at reasonable prices and accessible at times for your busy schedules: Southwestern Child Development Commission, www.swcdcinc.org – offers individual and group packages also ProSolutions courses are still available for a fee – offers individual and group packages also *Use the On-going Training Log to document training annually. Attach copies of certificates. Staff Education and Works – Once they complete EDU 119, T. Peterson and K. Petersen need to request an official, original transcript and complete their Works registration. They will need to mail an unopened copy to DCDEE or request that a hard copy or electronic copy be sent from COA to DCDEE. They need to register for Works or complete their Works accounts. Playground – It’s Spring! Be sure to keep the Virginia Creeper cut back off the fence. It’s not as toxic as Poison Ivy but can cause skin irritations. Plastic Bags – Plastic bags, even those used to store children’s clothing, has to be stored five feet or higher in classrooms with children younger than three years of age. Activity Centers – Your activity centers are coming together. Group like items together. All blocks and accessories need to be stored in the block center. Dramatic play materials need to be stored in the dramatic play center. In some cases, less is more. Don’t crowd the shelves. Add picture labels with words to children can easily identify where materials belong. The two preschool classrooms need more work on their activity centers. The following activity centers are required: art, blocks, books, dramatic play, and manipulatives. These materials need to be accessible daily. Science/nature, music and movement, and sand and water need to be offered weekly. Add a sandbox and water table outdoors. You are working with J. Davidson on the ERS. She can provide you with materials listings to provide the quantity and variety of materials for each center. Additional Comments: Raise NC Newsletter – If you are not receiving and reading the Raise NC Newsletter, you are missing out on current relevant information about early childhood issues in North Carolina, information about proposed rules, available trainings and other information that may be of interest to you. The Raise NC Newsletter is typically sent out weekly to all facility contact email addresses, but if your email is not the facility contact email address, you can go to the DCDEE Website, https://ncchildcare.ncdhhs.gov/ and click on the “What’s New” tab. Click on “What’s New” and enter your email address and name under “Sign Up for Updates”. As an early learning professional, you need to stay in the know about issues in North Carolina that affect you and your business. Share with your staff so they can be in the know too! I shared information on the following topics and emailed the information to you after the visit: 1. NCAEYC Advocacy Circle: A Space to Be Heard 2. Register Now for Impact Summitt – Saturday, 6/7/25 3. Important! NCID Password Rule Changing and Tips to Keep NCID Updated 4. Update on QRIS Modernization – Proposed Rules pending adoption 5. Moodle Helpful Hints 6. Environment Rating Scales – Get Ready for the 3’s! Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 11/20/2024 Number Present: 20 Completed Date: 11/20/2024 Age: From 0 To 4 Total Minutes: 435 Time In: 08:45 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements. Last Annual Compliance visit – 12/19/23 18-month compliance history from 5/14/23 – 11/13/24 = 85% Last Sanitation Inspection – 5/21/24 - Approved Last Fire Inspection – 10/18/24 – Passed *Sanitation and fire inspections are required at least annually by the date of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. Required Water, Lead Paint, and Asbestos Testing - The Clean Classrooms for Carolina Kids website reflects the following information about your center’s required three-year water testing and one-time lead paint testing, and asbestos testing: Three-year Water Testing – 8/16/24; due again 8/16/27 Lead Paint Testing – exempt 8/5/24 per survey review by RTI Asbestos Testing – exempt 8/5/24 per survey review by RTI Maintain any paperwork received by mail or email in your Program Records file. *Thank you for being proactive and getting this completed. S. Morris, Office Manager, assisted me with the visit in the morning. E. Oppong, Administrator, arrived in the afternoon and reviewed the visit summary with me. The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/2021, but new legislation (Senate Bill 425) has extended the “hold harmless” period until the new Quality Rating Improvement System (QRIS) is implemented. At this time, you may choose to complete a rated license assessment using the current rated license process or you may wait until the new QRIS is implemented. Note that the current program assessment tool is changing from the Early Childhood Environment Rating Scale – Revised (ECERS-R) to the Early Childhood Environment Rating Scale – 3 (ECERS-3) and from the Infant/Toddler Environment Rating Scale – Revised (ECERS-R) to the ITERS-e. Information and training on the new program assessment tool is available on the NC Rating License Assessment Project website at https://ncrlap.org/. See Additional Comments for updates on the modernized QRIS. This facility is owned by Healthy Environments Child Development Center Kdhnc, LLC. According to the NC Secretary of State's website, this limited liability company is current and active as of 11/13/24. Please contact me prior to any information change regarding the ownership of this facility. License information was current. Contact me to make any changes to address, phone, or email or to request changes to the license. I monitored the classrooms and spaces used for child care and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 1/1/2024 and Item Numbers Listing, effective 3/2024. I monitored six staff records, two children’s records and all program records. The facility does not offer transportation. Center Observations: Twenty children were present in four classrooms with a teacher in each classroom. The one infant and three toddlers in Space 3 scheduled their own day, eating, diapering, sleeping and playing on the floor, and the teacher followed their lead. Documentation of safe sleep checks was available for the one infant. All children had opportunities for indoor and outdoor play which included free choice activities and short group times. Lunches were brought from home. All parents completed Nutrition Opt-Out forms, but most lunches met nutritional guidelines. After lunch children rested on linen-covered cots. Activity plans were posted in each classroom. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. In one of two children's files reviewed, a parent listed mangoes as a food allergy/sensitivity. This was not posted in the classroom or in the kitchen. .0901(g) 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. An aerosol can of Sun Bum Kids sunscreen was stored in a cabinet out of reach of children, but the cabinet was not locked. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. In Space 5, Vicks Vapor Rub, Calagel, and Cortizone 10 were stored in an unlocked cabinet out of reach of children but were not maintained in locked storage. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. Medication authorization for Vicks Vapor Rub, Cortizone 10, and Calagel, all OTC medications, were completed on the twelve-month blanket permission form and not on the longer medication permission form that is valid for 30 days to 6 months and includes a medication administration log. 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. A jar of Vicks Vapor Rub expired in October 2024 and was not returned to the parent. .0803(12) 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). A staff person was due for a five-year Criminal Background Check by October 8, 2024 but did not complete the Criminal Background Check and receive the new Qualification Letter until October 22, 2024. G.S. 110-90.2(b) & .2703(n)&(o) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and reviewed it on my tablet with you, E. Oppong. Because my printer was not operating, I provided you with a one-page visit summary which you signed. I will email an electronic copy of the visit summary, enrollment page, and any other visit documents to you. Please respond that you receive the email and are able to print the documents. We reviewed the six violations documented during today’s visit. Three were corrected during to the visit. The other three were pending correction. Send evidence of correction to me so that I receive it no later than 12/4/24. Your compliance verification letter needs to state your facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. Do not include names of children in the compliance letter. Use their initials. Send compliance verification letter in an email from your center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. You may include the compliance verification as an attachment or in the body of the email. I will email a sample compliance verification letter to you. If sufficient information is not received by the due date, a follow-up visit may be conducted. Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. Technical Assistance With Documented Violations: #508: Allergy Posting – Even in a center where parents provide food, staff need to be very aware of children’s allergies especially when children are allergic or sensitive to different food or beverage items in case the child eating next to them happens to have that particular food. When reviewing children’s records, the parent of ZJ (Space 4 – toddlers) listed that he is allergic/sensitive to mangoes. While it may not be an official medical diagnosis, she included this information on the Child’s Application, and staff need to be aware of it. There was nothing posted in the classroom or kitchen (both required) informing staff. A teacher stated that the mother had never said anything about the possible sensitivity. Post the child’s allergy to mangoes in the kitchen and the classroom where he eats. Also review all children’s file to verify if parents listed any food allergies for their children and add them to the two postings. For your compliance verification letter, state the date when all children’s files have been reviewed and any allergies have been documented and posted in the classrooms and kitchen. #840: Storage of Aerosol Sprays – Aerosol spray cans or cans in which the contents are under pressure can be dangerous because they can explode, burning persons with the chemical inside the spray can and showering them with metal shrapnel from the can itself. In addition, if children find an aerosol spray can, they may model what they see their teachers and parents do and hit the trigger and accidentally spray the chemicals in their face or in another child’s face. An aerosol sunscreen, Sun Bum Kids, was stored out of reach of children in an unlocked cabinet in Space 5 (classroom for children two years of age). The Office Manager stated that they did not consider that it was an aerosol can and stored it out of reach because it was a sunscreen. She immediately moved it to locked storage. To protect staff and children, lock all aerosol sprays – disinfectants, air fresheners, sunscreen, shave cream etc. Acceptable locks include magnetic safety locks, locks requiring a key, combination locks, and padlocks. #841: Storage of Medication - Improper storge of medications results in millions of accidental poisonings in children annually. In Space 5, a jar of Vicks Vapor Rub, a bottle of Calagel, a topical analgesic for skin irritation, and a tube of Cortizone 10, a topical analgesic, were stored out of reach of children in a cabinet but were not locked. These types of medications are Over The Counter (OTC) medications that are required to be locked. These are not topical ointments like sunscreen, lotion, or diaper cream which can be stored out of reach of children. The Office Manager stated that they were not aware that these items were considered medications and not topical ointments. She immediately moved them to locked storage. (The Vicks Vapor Rub was also expired and needs to be returned to parent.) All medications (topical ointments and creams, OTC, and prescription) must be inaccessible to children. Diaper creams and lotions may be stored out of reach, on a shelf or in a cabinet at least five feet or higher. OTC and prescription medications must be locked. Consider having the locked box for the medications that need to be locked and a separate basket for diaper creams that need to be stored out of reach but easily accessible when prepping for diaper changes. #847: Medication Permission Forms - All medications for children present at the center must have a current, completed medication permission form that is appropriate for the type of medication being administered. Three Over The Counter (OTC) medications in Space 5 were accompanied by a 12-month blanket medication permission form but are required to have the longer medication permission form that is updated every 30 days for acute medical conditions or every 6 months for chronic medical conditions. These medications were Vicks Vapor Rub (SR – Space 2 preschool class); Cortizone 10 (SR – Space 2), and Calagel (SL- Space 2). The longer medication permission form also includes a medication administration log which must be completed when OTC medications are administered. The Office Manager stated that she was not aware of this. Instructions for the Cortizone 10 and the Calagel both state to not administer more than 3 to 4 times daily. This is why a medication administration log is needed so that you document when the medication was lasted given at home and each time it is given at the center to ensure the child does not receive an overdose of these types of medications. Provide the parents with the correct medication administration form. (The Vicks Vapor Rub is expired. It needs to be returned. If any of the other medications are no longer needed, return them also.) For your compliance letter, state the date when a correct medication permission form is available for Cortizone 10 and Calagel. *Multiple medication permission forms for topical ointments (sunscreens, diaper creams) only labeled the sunscreen as “sunscreen” or “diaper cream” and did not name the actual product such as “Sun Bum” or “Desitin”. Multiple sunscreens and diaper creams were not labeled with the child’s name or initials. Check all medications and verify that permission forms are complete and include the actual name of the product. Check that all medications are labeled. Keep a sharpie handy for this. #849: Expired Medication – Medication loses its potency when it is expired. In Space 5, a jar of Vicks Vapor Rub for Children (SR – Space 2) had an expiration date of October 2024 and was not returned to the parent. The expiration date on the medication permission form was incorrectly listed as October 2025. The Office Manager stated that they recently reviewed medication and medication permission forms but missed the error on the permission form. When medications or medication permission forms expire or child leaves center, return the medication to the parent within 72 hours unless the medication is still needed and the permission form needs to be updated. Check medication boxes or cabinets monthly to review medications and medication permission forms. Update or return as needed. Return the Vicks Vapor Rub to the parent of SR or discard and check all other medications in the center to verify that they are unexpired. For your compliance letter, state the date when the Vicks Vapor Rub is returned and when all medications are verified as unexpired. #1044: Criminal Background Check (CBC) – Criminal Background Checks ensure that staff have not committed any crimes which could potentially make them unsafe to be around children and other staff. Because Abuse and Neglect registries are also checked, it helps to ensure that children are protected from physical, mental, and sexual abuse. Performing diligent background screenings also protects the child care facility against future legal challenges. K. Pegues was due for a five-year Criminal Background Check by 10/8/24 but did not complete the CBC process and receive her new Qualification Letter until 10/22/24. You stated she initially had trouble with her NCID. Consider having staff start the CBC process (on-line application and payment and fingerprints) at least a month prior to expiration of previous CBC. Staff can keep their NCIDs active by logging into a platform (Moodle, Works, ABCMS) at least once a year. Or google NCID and log into the platform and log back out. The qualifying letter was available in K. Pegues’ file so no further action is required. Repeated violations of failing to complete Criminal Background Checks may result in an Administrative Action. General Visit Information: As a licensed child care facility, it is your responsibility to be knowledgeable of the child care laws and rules and to teach your staff the rules to ensure your center remains in compliance. The most recent versions of laws and rules regarding child care facilities in North Carolina are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. You can also review the “What’s New” section and download a copy of the Items Number Listing which you can use as a checklist for your program. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies and Child Care Health Consultants provide general training to meet on-going training hours, health and safety training requirements, Environment Rating Scale training and training specific to your center’s needs. They can also work with you to provide on-site technical assistance. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone – (252) 333-1233; website - www.aacfnc.org . *Healthy Behaviors Specialist: P. White – Phone (252) 333-1233; pam@aacfnc.org *Birth – 3 Quality Specialist: J. Davidson – Phone (252) 333-1233; joy@aacfnc.org *Southwestern Child Development Commission, www.swcdcinc.org - offers DCDEE approved, on-line, self-paced training with affordable annual packages allowing you to take as many courses as you need or want for one price. Reminders: ***CBC Provider Portal - Technical Assistance & Notification to the Division of New Hires or Residents 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 ABCMS Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. Then you will update this information in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Children’s Records – I reviewed two children's records, and they were complete. I really encourage you to use the Child’s Application for Enrollment to collect the required information you need – contact information, emergency contacts, approved pick-up list, health care needs (medical action plan, medication, allergies, unique behaviors, etc.), and authorization to seek emergency medical care. It is one page and much easier to copy for the Ready to Go File. Your “All About Me” pages where you ask very beneficial questions that are helpful to you and the staff provide a lot of insight. *If you choose to not use the Child’s Application for Enrollment, add the question “Does your child have a medical action plan? – yes or no” to your current form. Then explain that they need to provide you with a current copy of the medical action plan (updated annually and attached to the application). Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. *Encourage staff to maintain copies of all initial hire documents, Qualifying Letters, training certificates, etc. in their own professional file maintained at home. *Make it easier on yourself and schedule annual updates for staff evaluations and professional development plans; health questionnaires and emergency information forms; EPR Plan and Emergency Medical Care Plan at the same time to streamline your staff updates. (Example, even if an employee was hired in January , and you update health questionnaires and emergency forms in August, have this employee go ahead and update in August with the rest of the staff to jump into the same cycle!) *When I email staff worksheets to you prior to your Annual Compliance visit, you are expected to update them and return them prior to the date provided in the email. If you cannot open or work with an Excel document, I can send you a list of questions to answer. Use your staff worksheet as a working document and keep it updated as staff information is updated or changes *We reviewed your staff worksheet. I highlighted items that were delinquent and items that are coming due in the next year. Health and Safety Training and Five (5) Year Cycle Tracking Requirements – Review Row 17 on Staff Worksheet for initial and five-year H&S Training renewal dates. New staff need to complete Recognizing and Responding to Suspicions of Child Maltreatment and CPR/First Aid within three months of hire and the rest of the training modules within twelve months. All staff have current H&S Training except for T. Heater, hired 11/4/24. *T. Heater – CPR/First Aid & Recognizing and Responding to Suspicions of Child Maltreatment - due 2/24/25; rest of H&S Modules due 11/4/25 On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours returning staff will need by 11/30/25 (anniversary to today’s Annual Compliance visit). *ECE college coursework or coursework leading to an ECE degree counts towards on-going training hours. Each semester credit counts as 16 hours so a 3-credit classes also earns 48 hours of on-going training. *Staff who earn the NC Early Childhood Credential (NCECC) by taking EDU 119 will earn 64 on-going training hours and reduce their required number of hours from 20 to 10! *Check with your local Child Care Resource & Referral for available training. *Training available on Moodle *The following offer on-line training opportunities at reasonable prices and accessible at times for your busy schedules: Southwestern Child Development Commission, www.swcdcinc.org – offers individual and group packages also ProSolutions courses are still available for a fee – offers individual and group packages also *Use the On-going Training Log to document training annually. Attach copies of certificates. Lead Teacher Requirements – Lead Teachers who do not have the NC Early Childhood Credential (NCECC) or higher have six months to enroll in coursework that will lead to the NCECC (EDU 119 at the local community college) and eighteen months to complete it after enrollment. To remain qualified for a Lead Teacher position, T. Peterson and K. Petersen need to enroll in EDU 119 for the Spring 2025 semester and complete it by July 2026. T. Heater needs to enroll by May 2025 and complete by November 2026. Fire and Emergency Drills – current Playground Inspections - current Emergency Medical Care Plan – current and posted EPR Plan – last updated January 2024; The new administrator has completed EPR Training. Update the current EPR Plan by January 2024 and review with staff. * If you have questions, or need assistance with accessing your EPR Plan contact Amia M. Eaton, Training and Program Development Consultant Amia.Eaton@dhhs.nc.gov Sunscreen – Having individual sunscreens for each child is an application and storage nightmare. Consider offering one type of basic sunscreen for all children in the center. (Work the fee for this into your weekly fees or annual registration fee.) Then you only need one type of sunscreen for everyone and you can include the pre-written permission form with the annual update. No more juggling 18 cans of sunscreen. If parents want to use something else, they can apply it at home. Sanitation Requirements – There are multiple places throughout the center where the floor tiles are chipped or cracked exposing the subflooring underneath so that the floor cannot be adequately cleaned and sanitized. Covering these places with a rug does not resolve the issue. Replace the cracked, chipped tiles. Remove the bracket screwed to the floor by the sinks. The kitchen must be inaccessible to the children because of the hot water in the sinks. The Environmental Health Specialists have previously permitted the latch gate in the door way to prevent access; however, the latch on the gate is missing and the gate door can just swing either way. Fix the gate or replace it. Activity Centers – Your activity centers are coming together. Group like items together. All blocks and accessories need to be stored in the block center. Dramatic play materials need to be stored in the dramatic play center. In some cases, less is more. Don’t crowd the shelves. Add picture labels with words to children can easily identify where materials belong. The two preschool classrooms need more work on their activity centers. The following activity centers are required: art, blocks, books, dramatic play, and manipulatives. These materials need to be accessible daily. Science/nature, music and movement, and sand and water need to be offered weekly. Additional Comments: Annual License Fees - Keep an eye on your inbox for the 2024 annual license fee invoice. Invoices will be emailed to the facility addresses on file by November 30, 2024. Online payments will be due by December 31, 2024. In accordance with North Carolina General Statute § 110-90(1a), licensed child care facilities are assessed an annual license fee. The amount of your annual license fee is based on the licensed capacity printed on your license as of October 1, 2024, not the number of children enrolled at your facility. Please note that annual license fees do not apply to state or public school-operated child care facilities, or to religious-sponsored facilities operating under a Notice of Compliance. The Division of Child Development and Early Education remains available to assist you. For questions regarding license fees, visit the Frequently Asked Questions (FAQs) on our website. For further assistance regarding your annual license fee, please email DCDEE_LF@dhhs.nc.gov. I shared information on the following topics and emailed the information to you after the visit: 1. Free Webinar: Emotional Literacy 2. CBC Provider Portal – New Way to Attach Staff to Your License 3. Environment Rating Scales – Get Ready for the 3’s! 4. QRIS Update 5. Moodle Support 6. NCID – Keep it active! Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: ratio. Open / not marked corrected.

G.S. 110-90 · Violation

Name of Operation: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 11/20/2024 Number Present: 20 Completed Date: 11/20/2024 Age: From 0 To 4 Total Minutes: 435 Time In: 08:45 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements. Last Annual Compliance visit – 12/19/23 18-month compliance history from 5/14/23 – 11/13/24 = 85% Last Sanitation Inspection – 5/21/24 - Approved Last Fire Inspection – 10/18/24 – Passed *Sanitation and fire inspections are required at least annually by the date of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. Required Water, Lead Paint, and Asbestos Testing - The Clean Classrooms for Carolina Kids website reflects the following information about your center’s required three-year water testing and one-time lead paint testing, and asbestos testing: Three-year Water Testing – 8/16/24; due again 8/16/27 Lead Paint Testing – exempt 8/5/24 per survey review by RTI Asbestos Testing – exempt 8/5/24 per survey review by RTI Maintain any paperwork received by mail or email in your Program Records file. *Thank you for being proactive and getting this completed. S. Morris, Office Manager, assisted me with the visit in the morning. E. Oppong, Administrator, arrived in the afternoon and reviewed the visit summary with me. The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/2021, but new legislation (Senate Bill 425) has extended the “hold harmless” period until the new Quality Rating Improvement System (QRIS) is implemented. At this time, you may choose to complete a rated license assessment using the current rated license process or you may wait until the new QRIS is implemented. Note that the current program assessment tool is changing from the Early Childhood Environment Rating Scale – Revised (ECERS-R) to the Early Childhood Environment Rating Scale – 3 (ECERS-3) and from the Infant/Toddler Environment Rating Scale – Revised (ECERS-R) to the ITERS-e. Information and training on the new program assessment tool is available on the NC Rating License Assessment Project website at https://ncrlap.org/. See Additional Comments for updates on the modernized QRIS. This facility is owned by Healthy Environments Child Development Center Kdhnc, LLC. According to the NC Secretary of State's website, this limited liability company is current and active as of 11/13/24. Please contact me prior to any information change regarding the ownership of this facility. License information was current. Contact me to make any changes to address, phone, or email or to request changes to the license. I monitored the classrooms and spaces used for child care and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 1/1/2024 and Item Numbers Listing, effective 3/2024. I monitored six staff records, two children’s records and all program records. The facility does not offer transportation. Center Observations: Twenty children were present in four classrooms with a teacher in each classroom. The one infant and three toddlers in Space 3 scheduled their own day, eating, diapering, sleeping and playing on the floor, and the teacher followed their lead. Documentation of safe sleep checks was available for the one infant. All children had opportunities for indoor and outdoor play which included free choice activities and short group times. Lunches were brought from home. All parents completed Nutrition Opt-Out forms, but most lunches met nutritional guidelines. After lunch children rested on linen-covered cots. Activity plans were posted in each classroom. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. In one of two children's files reviewed, a parent listed mangoes as a food allergy/sensitivity. This was not posted in the classroom or in the kitchen. .0901(g) 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. An aerosol can of Sun Bum Kids sunscreen was stored in a cabinet out of reach of children, but the cabinet was not locked. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. In Space 5, Vicks Vapor Rub, Calagel, and Cortizone 10 were stored in an unlocked cabinet out of reach of children but were not maintained in locked storage. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. Medication authorization for Vicks Vapor Rub, Cortizone 10, and Calagel, all OTC medications, were completed on the twelve-month blanket permission form and not on the longer medication permission form that is valid for 30 days to 6 months and includes a medication administration log. 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. A jar of Vicks Vapor Rub expired in October 2024 and was not returned to the parent. .0803(12) 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). A staff person was due for a five-year Criminal Background Check by October 8, 2024 but did not complete the Criminal Background Check and receive the new Qualification Letter until October 22, 2024. G.S. 110-90.2(b) & .2703(n)&(o) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and reviewed it on my tablet with you, E. Oppong. Because my printer was not operating, I provided you with a one-page visit summary which you signed. I will email an electronic copy of the visit summary, enrollment page, and any other visit documents to you. Please respond that you receive the email and are able to print the documents. We reviewed the six violations documented during today’s visit. Three were corrected during to the visit. The other three were pending correction. Send evidence of correction to me so that I receive it no later than 12/4/24. Your compliance verification letter needs to state your facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. Do not include names of children in the compliance letter. Use their initials. Send compliance verification letter in an email from your center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. You may include the compliance verification as an attachment or in the body of the email. I will email a sample compliance verification letter to you. If sufficient information is not received by the due date, a follow-up visit may be conducted. Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. Technical Assistance With Documented Violations: #508: Allergy Posting – Even in a center where parents provide food, staff need to be very aware of children’s allergies especially when children are allergic or sensitive to different food or beverage items in case the child eating next to them happens to have that particular food. When reviewing children’s records, the parent of ZJ (Space 4 – toddlers) listed that he is allergic/sensitive to mangoes. While it may not be an official medical diagnosis, she included this information on the Child’s Application, and staff need to be aware of it. There was nothing posted in the classroom or kitchen (both required) informing staff. A teacher stated that the mother had never said anything about the possible sensitivity. Post the child’s allergy to mangoes in the kitchen and the classroom where he eats. Also review all children’s file to verify if parents listed any food allergies for their children and add them to the two postings. For your compliance verification letter, state the date when all children’s files have been reviewed and any allergies have been documented and posted in the classrooms and kitchen. #840: Storage of Aerosol Sprays – Aerosol spray cans or cans in which the contents are under pressure can be dangerous because they can explode, burning persons with the chemical inside the spray can and showering them with metal shrapnel from the can itself. In addition, if children find an aerosol spray can, they may model what they see their teachers and parents do and hit the trigger and accidentally spray the chemicals in their face or in another child’s face. An aerosol sunscreen, Sun Bum Kids, was stored out of reach of children in an unlocked cabinet in Space 5 (classroom for children two years of age). The Office Manager stated that they did not consider that it was an aerosol can and stored it out of reach because it was a sunscreen. She immediately moved it to locked storage. To protect staff and children, lock all aerosol sprays – disinfectants, air fresheners, sunscreen, shave cream etc. Acceptable locks include magnetic safety locks, locks requiring a key, combination locks, and padlocks. #841: Storage of Medication - Improper storge of medications results in millions of accidental poisonings in children annually. In Space 5, a jar of Vicks Vapor Rub, a bottle of Calagel, a topical analgesic for skin irritation, and a tube of Cortizone 10, a topical analgesic, were stored out of reach of children in a cabinet but were not locked. These types of medications are Over The Counter (OTC) medications that are required to be locked. These are not topical ointments like sunscreen, lotion, or diaper cream which can be stored out of reach of children. The Office Manager stated that they were not aware that these items were considered medications and not topical ointments. She immediately moved them to locked storage. (The Vicks Vapor Rub was also expired and needs to be returned to parent.) All medications (topical ointments and creams, OTC, and prescription) must be inaccessible to children. Diaper creams and lotions may be stored out of reach, on a shelf or in a cabinet at least five feet or higher. OTC and prescription medications must be locked. Consider having the locked box for the medications that need to be locked and a separate basket for diaper creams that need to be stored out of reach but easily accessible when prepping for diaper changes. #847: Medication Permission Forms - All medications for children present at the center must have a current, completed medication permission form that is appropriate for the type of medication being administered. Three Over The Counter (OTC) medications in Space 5 were accompanied by a 12-month blanket medication permission form but are required to have the longer medication permission form that is updated every 30 days for acute medical conditions or every 6 months for chronic medical conditions. These medications were Vicks Vapor Rub (SR – Space 2 preschool class); Cortizone 10 (SR – Space 2), and Calagel (SL- Space 2). The longer medication permission form also includes a medication administration log which must be completed when OTC medications are administered. The Office Manager stated that she was not aware of this. Instructions for the Cortizone 10 and the Calagel both state to not administer more than 3 to 4 times daily. This is why a medication administration log is needed so that you document when the medication was lasted given at home and each time it is given at the center to ensure the child does not receive an overdose of these types of medications. Provide the parents with the correct medication administration form. (The Vicks Vapor Rub is expired. It needs to be returned. If any of the other medications are no longer needed, return them also.) For your compliance letter, state the date when a correct medication permission form is available for Cortizone 10 and Calagel. *Multiple medication permission forms for topical ointments (sunscreens, diaper creams) only labeled the sunscreen as “sunscreen” or “diaper cream” and did not name the actual product such as “Sun Bum” or “Desitin”. Multiple sunscreens and diaper creams were not labeled with the child’s name or initials. Check all medications and verify that permission forms are complete and include the actual name of the product. Check that all medications are labeled. Keep a sharpie handy for this. #849: Expired Medication – Medication loses its potency when it is expired. In Space 5, a jar of Vicks Vapor Rub for Children (SR – Space 2) had an expiration date of October 2024 and was not returned to the parent. The expiration date on the medication permission form was incorrectly listed as October 2025. The Office Manager stated that they recently reviewed medication and medication permission forms but missed the error on the permission form. When medications or medication permission forms expire or child leaves center, return the medication to the parent within 72 hours unless the medication is still needed and the permission form needs to be updated. Check medication boxes or cabinets monthly to review medications and medication permission forms. Update or return as needed. Return the Vicks Vapor Rub to the parent of SR or discard and check all other medications in the center to verify that they are unexpired. For your compliance letter, state the date when the Vicks Vapor Rub is returned and when all medications are verified as unexpired. #1044: Criminal Background Check (CBC) – Criminal Background Checks ensure that staff have not committed any crimes which could potentially make them unsafe to be around children and other staff. Because Abuse and Neglect registries are also checked, it helps to ensure that children are protected from physical, mental, and sexual abuse. Performing diligent background screenings also protects the child care facility against future legal challenges. K. Pegues was due for a five-year Criminal Background Check by 10/8/24 but did not complete the CBC process and receive her new Qualification Letter until 10/22/24. You stated she initially had trouble with her NCID. Consider having staff start the CBC process (on-line application and payment and fingerprints) at least a month prior to expiration of previous CBC. Staff can keep their NCIDs active by logging into a platform (Moodle, Works, ABCMS) at least once a year. Or google NCID and log into the platform and log back out. The qualifying letter was available in K. Pegues’ file so no further action is required. Repeated violations of failing to complete Criminal Background Checks may result in an Administrative Action. General Visit Information: As a licensed child care facility, it is your responsibility to be knowledgeable of the child care laws and rules and to teach your staff the rules to ensure your center remains in compliance. The most recent versions of laws and rules regarding child care facilities in North Carolina are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. You can also review the “What’s New” section and download a copy of the Items Number Listing which you can use as a checklist for your program. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies and Child Care Health Consultants provide general training to meet on-going training hours, health and safety training requirements, Environment Rating Scale training and training specific to your center’s needs. They can also work with you to provide on-site technical assistance. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone – (252) 333-1233; website - www.aacfnc.org . *Healthy Behaviors Specialist: P. White – Phone (252) 333-1233; pam@aacfnc.org *Birth – 3 Quality Specialist: J. Davidson – Phone (252) 333-1233; joy@aacfnc.org *Southwestern Child Development Commission, www.swcdcinc.org - offers DCDEE approved, on-line, self-paced training with affordable annual packages allowing you to take as many courses as you need or want for one price. Reminders: ***CBC Provider Portal - Technical Assistance & Notification to the Division of New Hires or Residents 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 ABCMS Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. Then you will update this information in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Children’s Records – I reviewed two children's records, and they were complete. I really encourage you to use the Child’s Application for Enrollment to collect the required information you need – contact information, emergency contacts, approved pick-up list, health care needs (medical action plan, medication, allergies, unique behaviors, etc.), and authorization to seek emergency medical care. It is one page and much easier to copy for the Ready to Go File. Your “All About Me” pages where you ask very beneficial questions that are helpful to you and the staff provide a lot of insight. *If you choose to not use the Child’s Application for Enrollment, add the question “Does your child have a medical action plan? – yes or no” to your current form. Then explain that they need to provide you with a current copy of the medical action plan (updated annually and attached to the application). Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. *Encourage staff to maintain copies of all initial hire documents, Qualifying Letters, training certificates, etc. in their own professional file maintained at home. *Make it easier on yourself and schedule annual updates for staff evaluations and professional development plans; health questionnaires and emergency information forms; EPR Plan and Emergency Medical Care Plan at the same time to streamline your staff updates. (Example, even if an employee was hired in January , and you update health questionnaires and emergency forms in August, have this employee go ahead and update in August with the rest of the staff to jump into the same cycle!) *When I email staff worksheets to you prior to your Annual Compliance visit, you are expected to update them and return them prior to the date provided in the email. If you cannot open or work with an Excel document, I can send you a list of questions to answer. Use your staff worksheet as a working document and keep it updated as staff information is updated or changes *We reviewed your staff worksheet. I highlighted items that were delinquent and items that are coming due in the next year. Health and Safety Training and Five (5) Year Cycle Tracking Requirements – Review Row 17 on Staff Worksheet for initial and five-year H&S Training renewal dates. New staff need to complete Recognizing and Responding to Suspicions of Child Maltreatment and CPR/First Aid within three months of hire and the rest of the training modules within twelve months. All staff have current H&S Training except for T. Heater, hired 11/4/24. *T. Heater – CPR/First Aid & Recognizing and Responding to Suspicions of Child Maltreatment - due 2/24/25; rest of H&S Modules due 11/4/25 On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours returning staff will need by 11/30/25 (anniversary to today’s Annual Compliance visit). *ECE college coursework or coursework leading to an ECE degree counts towards on-going training hours. Each semester credit counts as 16 hours so a 3-credit classes also earns 48 hours of on-going training. *Staff who earn the NC Early Childhood Credential (NCECC) by taking EDU 119 will earn 64 on-going training hours and reduce their required number of hours from 20 to 10! *Check with your local Child Care Resource & Referral for available training. *Training available on Moodle *The following offer on-line training opportunities at reasonable prices and accessible at times for your busy schedules: Southwestern Child Development Commission, www.swcdcinc.org – offers individual and group packages also ProSolutions courses are still available for a fee – offers individual and group packages also *Use the On-going Training Log to document training annually. Attach copies of certificates. Lead Teacher Requirements – Lead Teachers who do not have the NC Early Childhood Credential (NCECC) or higher have six months to enroll in coursework that will lead to the NCECC (EDU 119 at the local community college) and eighteen months to complete it after enrollment. To remain qualified for a Lead Teacher position, T. Peterson and K. Petersen need to enroll in EDU 119 for the Spring 2025 semester and complete it by July 2026. T. Heater needs to enroll by May 2025 and complete by November 2026. Fire and Emergency Drills – current Playground Inspections - current Emergency Medical Care Plan – current and posted EPR Plan – last updated January 2024; The new administrator has completed EPR Training. Update the current EPR Plan by January 2024 and review with staff. * If you have questions, or need assistance with accessing your EPR Plan contact Amia M. Eaton, Training and Program Development Consultant Amia.Eaton@dhhs.nc.gov Sunscreen – Having individual sunscreens for each child is an application and storage nightmare. Consider offering one type of basic sunscreen for all children in the center. (Work the fee for this into your weekly fees or annual registration fee.) Then you only need one type of sunscreen for everyone and you can include the pre-written permission form with the annual update. No more juggling 18 cans of sunscreen. If parents want to use something else, they can apply it at home. Sanitation Requirements – There are multiple places throughout the center where the floor tiles are chipped or cracked exposing the subflooring underneath so that the floor cannot be adequately cleaned and sanitized. Covering these places with a rug does not resolve the issue. Replace the cracked, chipped tiles. Remove the bracket screwed to the floor by the sinks. The kitchen must be inaccessible to the children because of the hot water in the sinks. The Environmental Health Specialists have previously permitted the latch gate in the door way to prevent access; however, the latch on the gate is missing and the gate door can just swing either way. Fix the gate or replace it. Activity Centers – Your activity centers are coming together. Group like items together. All blocks and accessories need to be stored in the block center. Dramatic play materials need to be stored in the dramatic play center. In some cases, less is more. Don’t crowd the shelves. Add picture labels with words to children can easily identify where materials belong. The two preschool classrooms need more work on their activity centers. The following activity centers are required: art, blocks, books, dramatic play, and manipulatives. These materials need to be accessible daily. Science/nature, music and movement, and sand and water need to be offered weekly. Additional Comments: Annual License Fees - Keep an eye on your inbox for the 2024 annual license fee invoice. Invoices will be emailed to the facility addresses on file by November 30, 2024. Online payments will be due by December 31, 2024. In accordance with North Carolina General Statute § 110-90(1a), licensed child care facilities are assessed an annual license fee. The amount of your annual license fee is based on the licensed capacity printed on your license as of October 1, 2024, not the number of children enrolled at your facility. Please note that annual license fees do not apply to state or public school-operated child care facilities, or to religious-sponsored facilities operating under a Notice of Compliance. The Division of Child Development and Early Education remains available to assist you. For questions regarding license fees, visit the Frequently Asked Questions (FAQs) on our website. For further assistance regarding your annual license fee, please email DCDEE_LF@dhhs.nc.gov. I shared information on the following topics and emailed the information to you after the visit: 1. Free Webinar: Emotional Literacy 2. CBC Provider Portal – New Way to Attach Staff to Your License 3. Environment Rating Scales – Get Ready for the 3’s! 4. QRIS Update 5. Moodle Support 6. NCID – Keep it active! Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 11/20/2024 Number Present: 20 Completed Date: 11/20/2024 Age: From 0 To 4 Total Minutes: 435 Time In: 08:45 AM Time Out: 04:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements. Last Annual Compliance visit – 12/19/23 18-month compliance history from 5/14/23 – 11/13/24 = 85% Last Sanitation Inspection – 5/21/24 - Approved Last Fire Inspection – 10/18/24 – Passed *Sanitation and fire inspections are required at least annually by the date of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. Required Water, Lead Paint, and Asbestos Testing - The Clean Classrooms for Carolina Kids website reflects the following information about your center’s required three-year water testing and one-time lead paint testing, and asbestos testing: Three-year Water Testing – 8/16/24; due again 8/16/27 Lead Paint Testing – exempt 8/5/24 per survey review by RTI Asbestos Testing – exempt 8/5/24 per survey review by RTI Maintain any paperwork received by mail or email in your Program Records file. *Thank you for being proactive and getting this completed. S. Morris, Office Manager, assisted me with the visit in the morning. E. Oppong, Administrator, arrived in the afternoon and reviewed the visit summary with me. The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/2021, but new legislation (Senate Bill 425) has extended the “hold harmless” period until the new Quality Rating Improvement System (QRIS) is implemented. At this time, you may choose to complete a rated license assessment using the current rated license process or you may wait until the new QRIS is implemented. Note that the current program assessment tool is changing from the Early Childhood Environment Rating Scale – Revised (ECERS-R) to the Early Childhood Environment Rating Scale – 3 (ECERS-3) and from the Infant/Toddler Environment Rating Scale – Revised (ECERS-R) to the ITERS-e. Information and training on the new program assessment tool is available on the NC Rating License Assessment Project website at https://ncrlap.org/. See Additional Comments for updates on the modernized QRIS. This facility is owned by Healthy Environments Child Development Center Kdhnc, LLC. According to the NC Secretary of State's website, this limited liability company is current and active as of 11/13/24. Please contact me prior to any information change regarding the ownership of this facility. License information was current. Contact me to make any changes to address, phone, or email or to request changes to the license. I monitored the classrooms and spaces used for child care and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 1/1/2024 and Item Numbers Listing, effective 3/2024. I monitored six staff records, two children’s records and all program records. The facility does not offer transportation. Center Observations: Twenty children were present in four classrooms with a teacher in each classroom. The one infant and three toddlers in Space 3 scheduled their own day, eating, diapering, sleeping and playing on the floor, and the teacher followed their lead. Documentation of safe sleep checks was available for the one infant. All children had opportunities for indoor and outdoor play which included free choice activities and short group times. Lunches were brought from home. All parents completed Nutrition Opt-Out forms, but most lunches met nutritional guidelines. After lunch children rested on linen-covered cots. Activity plans were posted in each classroom. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 508 Special diet or food allergy information was not posted where they can be seen in food preparation and eating areas. In one of two children's files reviewed, a parent listed mangoes as a food allergy/sensitivity. This was not posted in the classroom or in the kitchen. .0901(g) 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. An aerosol can of Sun Bum Kids sunscreen was stored in a cabinet out of reach of children, but the cabinet was not locked. .2820(b) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. In Space 5, Vicks Vapor Rub, Calagel, and Cortizone 10 were stored in an unlocked cabinet out of reach of children but were not maintained in locked storage. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. Medication authorization for Vicks Vapor Rub, Cortizone 10, and Calagel, all OTC medications, were completed on the twelve-month blanket permission form and not on the longer medication permission form that is valid for 30 days to 6 months and includes a medication administration log. 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. A jar of Vicks Vapor Rub expired in October 2024 and was not returned to the parent. .0803(12) 1044 Prior to the expiration date of the qualification letter, the child care provider did not complete and submit required forms to complete a criminal background check (a qualification letter is valid for a maximum of five years for the date of issuance). A staff person was due for a five-year Criminal Background Check by October 8, 2024 but did not complete the Criminal Background Check and receive the new Qualification Letter until October 22, 2024. G.S. 110-90.2(b) & .2703(n)&(o) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and reviewed it on my tablet with you, E. Oppong. Because my printer was not operating, I provided you with a one-page visit summary which you signed. I will email an electronic copy of the visit summary, enrollment page, and any other visit documents to you. Please respond that you receive the email and are able to print the documents. We reviewed the six violations documented during today’s visit. Three were corrected during to the visit. The other three were pending correction. Send evidence of correction to me so that I receive it no later than 12/4/24. Your compliance verification letter needs to state your facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. Do not include names of children in the compliance letter. Use their initials. Send compliance verification letter in an email from your center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. You may include the compliance verification as an attachment or in the body of the email. I will email a sample compliance verification letter to you. If sufficient information is not received by the due date, a follow-up visit may be conducted. Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. Technical Assistance With Documented Violations: #508: Allergy Posting – Even in a center where parents provide food, staff need to be very aware of children’s allergies especially when children are allergic or sensitive to different food or beverage items in case the child eating next to them happens to have that particular food. When reviewing children’s records, the parent of ZJ (Space 4 – toddlers) listed that he is allergic/sensitive to mangoes. While it may not be an official medical diagnosis, she included this information on the Child’s Application, and staff need to be aware of it. There was nothing posted in the classroom or kitchen (both required) informing staff. A teacher stated that the mother had never said anything about the possible sensitivity. Post the child’s allergy to mangoes in the kitchen and the classroom where he eats. Also review all children’s file to verify if parents listed any food allergies for their children and add them to the two postings. For your compliance verification letter, state the date when all children’s files have been reviewed and any allergies have been documented and posted in the classrooms and kitchen. #840: Storage of Aerosol Sprays – Aerosol spray cans or cans in which the contents are under pressure can be dangerous because they can explode, burning persons with the chemical inside the spray can and showering them with metal shrapnel from the can itself. In addition, if children find an aerosol spray can, they may model what they see their teachers and parents do and hit the trigger and accidentally spray the chemicals in their face or in another child’s face. An aerosol sunscreen, Sun Bum Kids, was stored out of reach of children in an unlocked cabinet in Space 5 (classroom for children two years of age). The Office Manager stated that they did not consider that it was an aerosol can and stored it out of reach because it was a sunscreen. She immediately moved it to locked storage. To protect staff and children, lock all aerosol sprays – disinfectants, air fresheners, sunscreen, shave cream etc. Acceptable locks include magnetic safety locks, locks requiring a key, combination locks, and padlocks. #841: Storage of Medication - Improper storge of medications results in millions of accidental poisonings in children annually. In Space 5, a jar of Vicks Vapor Rub, a bottle of Calagel, a topical analgesic for skin irritation, and a tube of Cortizone 10, a topical analgesic, were stored out of reach of children in a cabinet but were not locked. These types of medications are Over The Counter (OTC) medications that are required to be locked. These are not topical ointments like sunscreen, lotion, or diaper cream which can be stored out of reach of children. The Office Manager stated that they were not aware that these items were considered medications and not topical ointments. She immediately moved them to locked storage. (The Vicks Vapor Rub was also expired and needs to be returned to parent.) All medications (topical ointments and creams, OTC, and prescription) must be inaccessible to children. Diaper creams and lotions may be stored out of reach, on a shelf or in a cabinet at least five feet or higher. OTC and prescription medications must be locked. Consider having the locked box for the medications that need to be locked and a separate basket for diaper creams that need to be stored out of reach but easily accessible when prepping for diaper changes. #847: Medication Permission Forms - All medications for children present at the center must have a current, completed medication permission form that is appropriate for the type of medication being administered. Three Over The Counter (OTC) medications in Space 5 were accompanied by a 12-month blanket medication permission form but are required to have the longer medication permission form that is updated every 30 days for acute medical conditions or every 6 months for chronic medical conditions. These medications were Vicks Vapor Rub (SR – Space 2 preschool class); Cortizone 10 (SR – Space 2), and Calagel (SL- Space 2). The longer medication permission form also includes a medication administration log which must be completed when OTC medications are administered. The Office Manager stated that she was not aware of this. Instructions for the Cortizone 10 and the Calagel both state to not administer more than 3 to 4 times daily. This is why a medication administration log is needed so that you document when the medication was lasted given at home and each time it is given at the center to ensure the child does not receive an overdose of these types of medications. Provide the parents with the correct medication administration form. (The Vicks Vapor Rub is expired. It needs to be returned. If any of the other medications are no longer needed, return them also.) For your compliance letter, state the date when a correct medication permission form is available for Cortizone 10 and Calagel. *Multiple medication permission forms for topical ointments (sunscreens, diaper creams) only labeled the sunscreen as “sunscreen” or “diaper cream” and did not name the actual product such as “Sun Bum” or “Desitin”. Multiple sunscreens and diaper creams were not labeled with the child’s name or initials. Check all medications and verify that permission forms are complete and include the actual name of the product. Check that all medications are labeled. Keep a sharpie handy for this. #849: Expired Medication – Medication loses its potency when it is expired. In Space 5, a jar of Vicks Vapor Rub for Children (SR – Space 2) had an expiration date of October 2024 and was not returned to the parent. The expiration date on the medication permission form was incorrectly listed as October 2025. The Office Manager stated that they recently reviewed medication and medication permission forms but missed the error on the permission form. When medications or medication permission forms expire or child leaves center, return the medication to the parent within 72 hours unless the medication is still needed and the permission form needs to be updated. Check medication boxes or cabinets monthly to review medications and medication permission forms. Update or return as needed. Return the Vicks Vapor Rub to the parent of SR or discard and check all other medications in the center to verify that they are unexpired. For your compliance letter, state the date when the Vicks Vapor Rub is returned and when all medications are verified as unexpired. #1044: Criminal Background Check (CBC) – Criminal Background Checks ensure that staff have not committed any crimes which could potentially make them unsafe to be around children and other staff. Because Abuse and Neglect registries are also checked, it helps to ensure that children are protected from physical, mental, and sexual abuse. Performing diligent background screenings also protects the child care facility against future legal challenges. K. Pegues was due for a five-year Criminal Background Check by 10/8/24 but did not complete the CBC process and receive her new Qualification Letter until 10/22/24. You stated she initially had trouble with her NCID. Consider having staff start the CBC process (on-line application and payment and fingerprints) at least a month prior to expiration of previous CBC. Staff can keep their NCIDs active by logging into a platform (Moodle, Works, ABCMS) at least once a year. Or google NCID and log into the platform and log back out. The qualifying letter was available in K. Pegues’ file so no further action is required. Repeated violations of failing to complete Criminal Background Checks may result in an Administrative Action. General Visit Information: As a licensed child care facility, it is your responsibility to be knowledgeable of the child care laws and rules and to teach your staff the rules to ensure your center remains in compliance. The most recent versions of laws and rules regarding child care facilities in North Carolina are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. You can also review the “What’s New” section and download a copy of the Items Number Listing which you can use as a checklist for your program. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies and Child Care Health Consultants provide general training to meet on-going training hours, health and safety training requirements, Environment Rating Scale training and training specific to your center’s needs. They can also work with you to provide on-site technical assistance. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone – (252) 333-1233; website - www.aacfnc.org . *Healthy Behaviors Specialist: P. White – Phone (252) 333-1233; pam@aacfnc.org *Birth – 3 Quality Specialist: J. Davidson – Phone (252) 333-1233; joy@aacfnc.org *Southwestern Child Development Commission, www.swcdcinc.org - offers DCDEE approved, on-line, self-paced training with affordable annual packages allowing you to take as many courses as you need or want for one price. Reminders: ***CBC Provider Portal - Technical Assistance & Notification to the Division of New Hires or Residents 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 ABCMS Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. Then you will update this information in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. Children’s Records – I reviewed two children's records, and they were complete. I really encourage you to use the Child’s Application for Enrollment to collect the required information you need – contact information, emergency contacts, approved pick-up list, health care needs (medical action plan, medication, allergies, unique behaviors, etc.), and authorization to seek emergency medical care. It is one page and much easier to copy for the Ready to Go File. Your “All About Me” pages where you ask very beneficial questions that are helpful to you and the staff provide a lot of insight. *If you choose to not use the Child’s Application for Enrollment, add the question “Does your child have a medical action plan? – yes or no” to your current form. Then explain that they need to provide you with a current copy of the medical action plan (updated annually and attached to the application). Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. *Encourage staff to maintain copies of all initial hire documents, Qualifying Letters, training certificates, etc. in their own professional file maintained at home. *Make it easier on yourself and schedule annual updates for staff evaluations and professional development plans; health questionnaires and emergency information forms; EPR Plan and Emergency Medical Care Plan at the same time to streamline your staff updates. (Example, even if an employee was hired in January , and you update health questionnaires and emergency forms in August, have this employee go ahead and update in August with the rest of the staff to jump into the same cycle!) *When I email staff worksheets to you prior to your Annual Compliance visit, you are expected to update them and return them prior to the date provided in the email. If you cannot open or work with an Excel document, I can send you a list of questions to answer. Use your staff worksheet as a working document and keep it updated as staff information is updated or changes *We reviewed your staff worksheet. I highlighted items that were delinquent and items that are coming due in the next year. Health and Safety Training and Five (5) Year Cycle Tracking Requirements – Review Row 17 on Staff Worksheet for initial and five-year H&S Training renewal dates. New staff need to complete Recognizing and Responding to Suspicions of Child Maltreatment and CPR/First Aid within three months of hire and the rest of the training modules within twelve months. All staff have current H&S Training except for T. Heater, hired 11/4/24. *T. Heater – CPR/First Aid & Recognizing and Responding to Suspicions of Child Maltreatment - due 2/24/25; rest of H&S Modules due 11/4/25 On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours returning staff will need by 11/30/25 (anniversary to today’s Annual Compliance visit). *ECE college coursework or coursework leading to an ECE degree counts towards on-going training hours. Each semester credit counts as 16 hours so a 3-credit classes also earns 48 hours of on-going training. *Staff who earn the NC Early Childhood Credential (NCECC) by taking EDU 119 will earn 64 on-going training hours and reduce their required number of hours from 20 to 10! *Check with your local Child Care Resource & Referral for available training. *Training available on Moodle *The following offer on-line training opportunities at reasonable prices and accessible at times for your busy schedules: Southwestern Child Development Commission, www.swcdcinc.org – offers individual and group packages also ProSolutions courses are still available for a fee – offers individual and group packages also *Use the On-going Training Log to document training annually. Attach copies of certificates. Lead Teacher Requirements – Lead Teachers who do not have the NC Early Childhood Credential (NCECC) or higher have six months to enroll in coursework that will lead to the NCECC (EDU 119 at the local community college) and eighteen months to complete it after enrollment. To remain qualified for a Lead Teacher position, T. Peterson and K. Petersen need to enroll in EDU 119 for the Spring 2025 semester and complete it by July 2026. T. Heater needs to enroll by May 2025 and complete by November 2026. Fire and Emergency Drills – current Playground Inspections - current Emergency Medical Care Plan – current and posted EPR Plan – last updated January 2024; The new administrator has completed EPR Training. Update the current EPR Plan by January 2024 and review with staff. * If you have questions, or need assistance with accessing your EPR Plan contact Amia M. Eaton, Training and Program Development Consultant Amia.Eaton@dhhs.nc.gov Sunscreen – Having individual sunscreens for each child is an application and storage nightmare. Consider offering one type of basic sunscreen for all children in the center. (Work the fee for this into your weekly fees or annual registration fee.) Then you only need one type of sunscreen for everyone and you can include the pre-written permission form with the annual update. No more juggling 18 cans of sunscreen. If parents want to use something else, they can apply it at home. Sanitation Requirements – There are multiple places throughout the center where the floor tiles are chipped or cracked exposing the subflooring underneath so that the floor cannot be adequately cleaned and sanitized. Covering these places with a rug does not resolve the issue. Replace the cracked, chipped tiles. Remove the bracket screwed to the floor by the sinks. The kitchen must be inaccessible to the children because of the hot water in the sinks. The Environmental Health Specialists have previously permitted the latch gate in the door way to prevent access; however, the latch on the gate is missing and the gate door can just swing either way. Fix the gate or replace it. Activity Centers – Your activity centers are coming together. Group like items together. All blocks and accessories need to be stored in the block center. Dramatic play materials need to be stored in the dramatic play center. In some cases, less is more. Don’t crowd the shelves. Add picture labels with words to children can easily identify where materials belong. The two preschool classrooms need more work on their activity centers. The following activity centers are required: art, blocks, books, dramatic play, and manipulatives. These materials need to be accessible daily. Science/nature, music and movement, and sand and water need to be offered weekly. Additional Comments: Annual License Fees - Keep an eye on your inbox for the 2024 annual license fee invoice. Invoices will be emailed to the facility addresses on file by November 30, 2024. Online payments will be due by December 31, 2024. In accordance with North Carolina General Statute § 110-90(1a), licensed child care facilities are assessed an annual license fee. The amount of your annual license fee is based on the licensed capacity printed on your license as of October 1, 2024, not the number of children enrolled at your facility. Please note that annual license fees do not apply to state or public school-operated child care facilities, or to religious-sponsored facilities operating under a Notice of Compliance. The Division of Child Development and Early Education remains available to assist you. For questions regarding license fees, visit the Frequently Asked Questions (FAQs) on our website. For further assistance regarding your annual license fee, please email DCDEE_LF@dhhs.nc.gov. I shared information on the following topics and emailed the information to you after the visit: 1. Free Webinar: Emotional Literacy 2. CBC Provider Portal – New Way to Attach Staff to Your License 3. Environment Rating Scales – Get Ready for the 3’s! 4. QRIS Update 5. Moodle Support 6. NCID – Keep it active! Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0924-346L Visit Date: 9/24/2024 Number Present: 15 Completed Date: 9/24/2024 Age: From 0 To 4 Total Minutes: 230 Time In: 02:10 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: 1. There is a concern that children were cared for in an unsafe environment. 2. There is a concern that sanitation guidelines were not followed. E. Oppong, Owner/Administrator, was not present, but center staff assisted me with the visit. I spoke with Ms. Oppong over the phone. I completed a walk-through of the center and completed limited monitoring of child care requirements during the visit. Supervision of children, staff/child ratios, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. Investigation: The allegations were shared with the administrator over the phone and four staff members. Allegation #1: There is a concern that children were cared for in an unsafe environment. Your Responses: The teachers stated that the center had been painted with what looked like spray paint over the weekend. When two of them arrived to open the center on Monday, 9/23/2024, they noticed a strong odor from the spray paint. Because the fumes were still strong, one staff person requested to go home. Other staff stated that the odor gave them a slight headache and nausea; however, they chose to stay. They took the children outside for the morning and opened the front and back doors to help ventilate the space. A parent offered three floor fans that they set up in the spaces outside the classrooms. They stated that one parent commented about the strong odor and picked up their child early yesterday and today so the child would not have to eat and nap in the building. They stated that the smell while still noticeable was much improved today. The administrator stated that she and her family deep cleaned the center over the weekend due to the recent spread of hand, foot and mouth disease. She also spray-painted the classroom walls using cans of Rust Oleum Painters Touch 2X Ultracover Paint and Primer. Because there are no operable windows in the child care center, when cleaning and painting over the weekend, she had left the doors open for ventilation but they were closed back up when she left on Sunday night. She stated that she had used this paint to paint her child care center in Virginia and had not had any complaints. The administrator stated that she sent she sent out a message on Bright Wheel to all parents informing them that they had deep cleaned and painted the building over the weekend and if they had concerns about the fumes, she could close the center for the day. She did not hear back from any of the parents. My Observations: When I arrived, the children in Spaces 2, 3, and 5 were napping. The center appeared to be very clean. Two large floor fans, located at the front and back of the building, were operating. There was a chemical odor. It was not overwhelming, but it was detectable. To me, the smell seemed to be more from spray paint rather than cleaning products. The walls appeared to have been sprayed painted: Space 1 – blue, Space 2 – yellow, Space 4 – aqua, Space 5 – red. I monitored sign-in/sign-out sheets and observed that a child was picked up around noon on Monday, 9/23/2024 and today, Tuesday, 9/24/2024. The administrator texted a picture of the spray paint that she had used. I researched the instructions for the spray paint which stated to use in a well-ventilated space and allow to dry for 24 hours. The administrator asked me to review the Bright Wheel message she sent out to parents. It was sent on Monday, 9/23/2024 at 1:54pm and said, “Good afternoon parents and guardians, inside of the building was painted on Saturday and we also did some deep cleaning of the building. We had the doors opened all weekend and all the today to get rid of the fumes from the cleaning. If you have any concerns, please let me know and I will be happy to close the daycare down for the day.” Also, several parents arriving to pick up their children commented that the smell was not as bad today as yesterday. Based upon your statements and my observations, this allegation is confirmed. Floor fans were used to ventilate the building due to the strong odor/fumes present from cleaning products and spray paint used over the weekend. Because the building does not have operable windows and doors with screens, it needed to be opened for ventilation an extra day without children present to allow the fumes to dissipate. Allegation #2: There is a concern that sanitation guidelines were not followed. Your Responses: The teachers and administrator stated that the front and back door were left open on Monday, 9/23/2024 to help ventilate the building after being cleaned and painted over the weekend. My Observations: The doors were not open today when I arrived, but I read a Bright Wheel message that stated, “We had the doors opened all weekend and all the today to get rid of the fumes from the cleaning.” Based upon your statements and my observations, this allegation is confirmed. Doors with no screen were left open making the building accessible to flying insects. The following items were documented as violations during today’s visit: Violation Number Comment Rule 617 All openings to the outer air were not protected against the entrance of flying pest. On Monday, September 23, 2024, doors to the center were left opened for ventilation due to a strong chemical smell after the center was painted over the weekend. The doors were not screened to protect against flying pests. 15A NCAC 18A .2831(c) 807 A safe indoor and outdoor environment was not provided for the children. The center was not closed on Monday, September 23, 2024 when a strong chemical odor was still present after it was deep cleaned and painted over the weekend. 10A NCAC 09 .0601(a) 813 Electric fans were not mounted out of reach or did not have a mesh guard to prevent access. Three electric floor fans, used to ventilate the center, were not mounted out of reach or protected with a mesh guard and were accessible to children. 10A NCAC 09 .0604(d) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to L. Rock, Lead Teacher to sign that it was received. I emailed an electronic copy to E. Oppong, Administrator. The three violations have been corrected so no further action is required except to maintain compliance in the future. The administrator was not expecting the fumes from the spray paint to linger as long as they did and was not aware of the rules regarding the use of fans and open doors with no screens for ventilation. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. Technical Assistance with Documented Violations: #617: Open Windows/Doors– To prevent flying pests from entering the building, all windows and doors, if left open need to be screened. On Monday, 9/23/2024, staff left the front and back door open to help ventilate the center after it had been cleaned and painted over the weekend and a strong chemical odor was present on Monday morning. The staff stated that they were not aware that the doors could not remain open and felt it was needed to ventilate the building due to the strong fumes. A better solution would have been to close the center for the day. Once the staff realized that after being closed up on Sunday night and the chemical fumes were still strong on Monday morning, the administrator should have made the decision to close the center for the day and continue to ventilate it an extra day with open doors and fans. #807: Safe Indoor Environment – Providing a well-ventilated building without strong chemicals keeps children safe and healthy. The owner deep cleaned and spray-painted the center over the weekend, but because the space is not well-ventilated, the fumes from the chemicals and spray paint were still strong on Monday, 9/23/2024 when the center reopened. The teachers kept the children outdoors for the morning and used open doors and fans to ventilate the space. A better solution would have been to make the decision to close the center for an extra day to allow it to air out, keeping children and staff safe. #813: Electric Fans – The spaces between the fan guard grates on electric fans are large enough that a child could stick a finger in the fan possibly resulting in a serious injury. On Monday, 9/23/2024 and Tuesday, 9/24/2024, electric fans were placed in the spaces outside the classrooms, but still accessible to children, to increase ventilation in the center due to a strong odor of spray paint. A teacher stated that she nor the administrator were aware that that use of the fans was a safety issue. They were just trying to help dissipate the spray paint fumes. Electric fans must be either mounted out of reach of children, at least five feet or higher, off the finished floor or covered with a fan mesh which can be purchased at most hardware stores. The fans were immediately removed from the building. Compliance History: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 3/20/23 – 9/19/24 = 86%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to the section labeled Technical Assistance for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0924-346L Visit Date: 9/24/2024 Number Present: 15 Completed Date: 9/24/2024 Age: From 0 To 4 Total Minutes: 230 Time In: 02:10 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: 1. There is a concern that children were cared for in an unsafe environment. 2. There is a concern that sanitation guidelines were not followed. E. Oppong, Owner/Administrator, was not present, but center staff assisted me with the visit. I spoke with Ms. Oppong over the phone. I completed a walk-through of the center and completed limited monitoring of child care requirements during the visit. Supervision of children, staff/child ratios, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. Investigation: The allegations were shared with the administrator over the phone and four staff members. Allegation #1: There is a concern that children were cared for in an unsafe environment. Your Responses: The teachers stated that the center had been painted with what looked like spray paint over the weekend. When two of them arrived to open the center on Monday, 9/23/2024, they noticed a strong odor from the spray paint. Because the fumes were still strong, one staff person requested to go home. Other staff stated that the odor gave them a slight headache and nausea; however, they chose to stay. They took the children outside for the morning and opened the front and back doors to help ventilate the space. A parent offered three floor fans that they set up in the spaces outside the classrooms. They stated that one parent commented about the strong odor and picked up their child early yesterday and today so the child would not have to eat and nap in the building. They stated that the smell while still noticeable was much improved today. The administrator stated that she and her family deep cleaned the center over the weekend due to the recent spread of hand, foot and mouth disease. She also spray-painted the classroom walls using cans of Rust Oleum Painters Touch 2X Ultracover Paint and Primer. Because there are no operable windows in the child care center, when cleaning and painting over the weekend, she had left the doors open for ventilation but they were closed back up when she left on Sunday night. She stated that she had used this paint to paint her child care center in Virginia and had not had any complaints. The administrator stated that she sent she sent out a message on Bright Wheel to all parents informing them that they had deep cleaned and painted the building over the weekend and if they had concerns about the fumes, she could close the center for the day. She did not hear back from any of the parents. My Observations: When I arrived, the children in Spaces 2, 3, and 5 were napping. The center appeared to be very clean. Two large floor fans, located at the front and back of the building, were operating. There was a chemical odor. It was not overwhelming, but it was detectable. To me, the smell seemed to be more from spray paint rather than cleaning products. The walls appeared to have been sprayed painted: Space 1 – blue, Space 2 – yellow, Space 4 – aqua, Space 5 – red. I monitored sign-in/sign-out sheets and observed that a child was picked up around noon on Monday, 9/23/2024 and today, Tuesday, 9/24/2024. The administrator texted a picture of the spray paint that she had used. I researched the instructions for the spray paint which stated to use in a well-ventilated space and allow to dry for 24 hours. The administrator asked me to review the Bright Wheel message she sent out to parents. It was sent on Monday, 9/23/2024 at 1:54pm and said, “Good afternoon parents and guardians, inside of the building was painted on Saturday and we also did some deep cleaning of the building. We had the doors opened all weekend and all the today to get rid of the fumes from the cleaning. If you have any concerns, please let me know and I will be happy to close the daycare down for the day.” Also, several parents arriving to pick up their children commented that the smell was not as bad today as yesterday. Based upon your statements and my observations, this allegation is confirmed. Floor fans were used to ventilate the building due to the strong odor/fumes present from cleaning products and spray paint used over the weekend. Because the building does not have operable windows and doors with screens, it needed to be opened for ventilation an extra day without children present to allow the fumes to dissipate. Allegation #2: There is a concern that sanitation guidelines were not followed. Your Responses: The teachers and administrator stated that the front and back door were left open on Monday, 9/23/2024 to help ventilate the building after being cleaned and painted over the weekend. My Observations: The doors were not open today when I arrived, but I read a Bright Wheel message that stated, “We had the doors opened all weekend and all the today to get rid of the fumes from the cleaning.” Based upon your statements and my observations, this allegation is confirmed. Doors with no screen were left open making the building accessible to flying insects. The following items were documented as violations during today’s visit: Violation Number Comment Rule 617 All openings to the outer air were not protected against the entrance of flying pest. On Monday, September 23, 2024, doors to the center were left opened for ventilation due to a strong chemical smell after the center was painted over the weekend. The doors were not screened to protect against flying pests. 15A NCAC 18A .2831(c) 807 A safe indoor and outdoor environment was not provided for the children. The center was not closed on Monday, September 23, 2024 when a strong chemical odor was still present after it was deep cleaned and painted over the weekend. 10A NCAC 09 .0601(a) 813 Electric fans were not mounted out of reach or did not have a mesh guard to prevent access. Three electric floor fans, used to ventilate the center, were not mounted out of reach or protected with a mesh guard and were accessible to children. 10A NCAC 09 .0604(d) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to L. Rock, Lead Teacher to sign that it was received. I emailed an electronic copy to E. Oppong, Administrator. The three violations have been corrected so no further action is required except to maintain compliance in the future. The administrator was not expecting the fumes from the spray paint to linger as long as they did and was not aware of the rules regarding the use of fans and open doors with no screens for ventilation. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. Technical Assistance with Documented Violations: #617: Open Windows/Doors– To prevent flying pests from entering the building, all windows and doors, if left open need to be screened. On Monday, 9/23/2024, staff left the front and back door open to help ventilate the center after it had been cleaned and painted over the weekend and a strong chemical odor was present on Monday morning. The staff stated that they were not aware that the doors could not remain open and felt it was needed to ventilate the building due to the strong fumes. A better solution would have been to close the center for the day. Once the staff realized that after being closed up on Sunday night and the chemical fumes were still strong on Monday morning, the administrator should have made the decision to close the center for the day and continue to ventilate it an extra day with open doors and fans. #807: Safe Indoor Environment – Providing a well-ventilated building without strong chemicals keeps children safe and healthy. The owner deep cleaned and spray-painted the center over the weekend, but because the space is not well-ventilated, the fumes from the chemicals and spray paint were still strong on Monday, 9/23/2024 when the center reopened. The teachers kept the children outdoors for the morning and used open doors and fans to ventilate the space. A better solution would have been to make the decision to close the center for an extra day to allow it to air out, keeping children and staff safe. #813: Electric Fans – The spaces between the fan guard grates on electric fans are large enough that a child could stick a finger in the fan possibly resulting in a serious injury. On Monday, 9/23/2024 and Tuesday, 9/24/2024, electric fans were placed in the spaces outside the classrooms, but still accessible to children, to increase ventilation in the center due to a strong odor of spray paint. A teacher stated that she nor the administrator were aware that that use of the fans was a safety issue. They were just trying to help dissipate the spray paint fumes. Electric fans must be either mounted out of reach of children, at least five feet or higher, off the finished floor or covered with a fan mesh which can be purchased at most hardware stores. The fans were immediately removed from the building. Compliance History: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 3/20/23 – 9/19/24 = 86%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to the section labeled Technical Assistance for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0924-346L Visit Date: 9/24/2024 Number Present: 15 Completed Date: 9/24/2024 Age: From 0 To 4 Total Minutes: 230 Time In: 02:10 PM Time Out: 06:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: 1. There is a concern that children were cared for in an unsafe environment. 2. There is a concern that sanitation guidelines were not followed. E. Oppong, Owner/Administrator, was not present, but center staff assisted me with the visit. I spoke with Ms. Oppong over the phone. I completed a walk-through of the center and completed limited monitoring of child care requirements during the visit. Supervision of children, staff/child ratios, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. Investigation: The allegations were shared with the administrator over the phone and four staff members. Allegation #1: There is a concern that children were cared for in an unsafe environment. Your Responses: The teachers stated that the center had been painted with what looked like spray paint over the weekend. When two of them arrived to open the center on Monday, 9/23/2024, they noticed a strong odor from the spray paint. Because the fumes were still strong, one staff person requested to go home. Other staff stated that the odor gave them a slight headache and nausea; however, they chose to stay. They took the children outside for the morning and opened the front and back doors to help ventilate the space. A parent offered three floor fans that they set up in the spaces outside the classrooms. They stated that one parent commented about the strong odor and picked up their child early yesterday and today so the child would not have to eat and nap in the building. They stated that the smell while still noticeable was much improved today. The administrator stated that she and her family deep cleaned the center over the weekend due to the recent spread of hand, foot and mouth disease. She also spray-painted the classroom walls using cans of Rust Oleum Painters Touch 2X Ultracover Paint and Primer. Because there are no operable windows in the child care center, when cleaning and painting over the weekend, she had left the doors open for ventilation but they were closed back up when she left on Sunday night. She stated that she had used this paint to paint her child care center in Virginia and had not had any complaints. The administrator stated that she sent she sent out a message on Bright Wheel to all parents informing them that they had deep cleaned and painted the building over the weekend and if they had concerns about the fumes, she could close the center for the day. She did not hear back from any of the parents. My Observations: When I arrived, the children in Spaces 2, 3, and 5 were napping. The center appeared to be very clean. Two large floor fans, located at the front and back of the building, were operating. There was a chemical odor. It was not overwhelming, but it was detectable. To me, the smell seemed to be more from spray paint rather than cleaning products. The walls appeared to have been sprayed painted: Space 1 – blue, Space 2 – yellow, Space 4 – aqua, Space 5 – red. I monitored sign-in/sign-out sheets and observed that a child was picked up around noon on Monday, 9/23/2024 and today, Tuesday, 9/24/2024. The administrator texted a picture of the spray paint that she had used. I researched the instructions for the spray paint which stated to use in a well-ventilated space and allow to dry for 24 hours. The administrator asked me to review the Bright Wheel message she sent out to parents. It was sent on Monday, 9/23/2024 at 1:54pm and said, “Good afternoon parents and guardians, inside of the building was painted on Saturday and we also did some deep cleaning of the building. We had the doors opened all weekend and all the today to get rid of the fumes from the cleaning. If you have any concerns, please let me know and I will be happy to close the daycare down for the day.” Also, several parents arriving to pick up their children commented that the smell was not as bad today as yesterday. Based upon your statements and my observations, this allegation is confirmed. Floor fans were used to ventilate the building due to the strong odor/fumes present from cleaning products and spray paint used over the weekend. Because the building does not have operable windows and doors with screens, it needed to be opened for ventilation an extra day without children present to allow the fumes to dissipate. Allegation #2: There is a concern that sanitation guidelines were not followed. Your Responses: The teachers and administrator stated that the front and back door were left open on Monday, 9/23/2024 to help ventilate the building after being cleaned and painted over the weekend. My Observations: The doors were not open today when I arrived, but I read a Bright Wheel message that stated, “We had the doors opened all weekend and all the today to get rid of the fumes from the cleaning.” Based upon your statements and my observations, this allegation is confirmed. Doors with no screen were left open making the building accessible to flying insects. The following items were documented as violations during today’s visit: Violation Number Comment Rule 617 All openings to the outer air were not protected against the entrance of flying pest. On Monday, September 23, 2024, doors to the center were left opened for ventilation due to a strong chemical smell after the center was painted over the weekend. The doors were not screened to protect against flying pests. 15A NCAC 18A .2831(c) 807 A safe indoor and outdoor environment was not provided for the children. The center was not closed on Monday, September 23, 2024 when a strong chemical odor was still present after it was deep cleaned and painted over the weekend. 10A NCAC 09 .0601(a) 813 Electric fans were not mounted out of reach or did not have a mesh guard to prevent access. Three electric floor fans, used to ventilate the center, were not mounted out of reach or protected with a mesh guard and were accessible to children. 10A NCAC 09 .0604(d) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to L. Rock, Lead Teacher to sign that it was received. I emailed an electronic copy to E. Oppong, Administrator. The three violations have been corrected so no further action is required except to maintain compliance in the future. The administrator was not expecting the fumes from the spray paint to linger as long as they did and was not aware of the rules regarding the use of fans and open doors with no screens for ventilation. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. Technical Assistance with Documented Violations: #617: Open Windows/Doors– To prevent flying pests from entering the building, all windows and doors, if left open need to be screened. On Monday, 9/23/2024, staff left the front and back door open to help ventilate the center after it had been cleaned and painted over the weekend and a strong chemical odor was present on Monday morning. The staff stated that they were not aware that the doors could not remain open and felt it was needed to ventilate the building due to the strong fumes. A better solution would have been to close the center for the day. Once the staff realized that after being closed up on Sunday night and the chemical fumes were still strong on Monday morning, the administrator should have made the decision to close the center for the day and continue to ventilate it an extra day with open doors and fans. #807: Safe Indoor Environment – Providing a well-ventilated building without strong chemicals keeps children safe and healthy. The owner deep cleaned and spray-painted the center over the weekend, but because the space is not well-ventilated, the fumes from the chemicals and spray paint were still strong on Monday, 9/23/2024 when the center reopened. The teachers kept the children outdoors for the morning and used open doors and fans to ventilate the space. A better solution would have been to make the decision to close the center for an extra day to allow it to air out, keeping children and staff safe. #813: Electric Fans – The spaces between the fan guard grates on electric fans are large enough that a child could stick a finger in the fan possibly resulting in a serious injury. On Monday, 9/23/2024 and Tuesday, 9/24/2024, electric fans were placed in the spaces outside the classrooms, but still accessible to children, to increase ventilation in the center due to a strong odor of spray paint. A teacher stated that she nor the administrator were aware that that use of the fans was a safety issue. They were just trying to help dissipate the spray paint fumes. Electric fans must be either mounted out of reach of children, at least five feet or higher, off the finished floor or covered with a fan mesh which can be purchased at most hardware stores. The fans were immediately removed from the building. Compliance History: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 3/20/23 – 9/19/24 = 86%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to the section labeled Technical Assistance for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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 .0804 · Violation

Name of Operation: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0524-368L Visit Date: 6/4/2024 Number Present: 19 Completed Date: 6/4/2024 Age: From 0 To 5 Total Minutes: 75 Time In: 02:30 PM Time Out: 03:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding an alleged violation of child care requirements. The allegation is as follows: There is a concern regarding sanitation guidelines. E. Oppong, Administrator, was not present, but S. Morris, Lead Floater, assisted me with a walk-through of the center. I completed limited monitoring of child care requirements during the visit. Supervision of children, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. I observed a staff/child ratio violation but documented it on the Routine Unannounced visit competed in conjunction with this Complaint visit. I received information regarding the allegation from a collaborative partner prior to the visit. Investigation: The allegations were shared with the administrator over the phone and one staff member. Additional information was provided by a collaborative partner before the visit. Allegation #1: There is a concern regarding sanitation guidelines. Your Responses: Staff stated that several children in Spaces 3 and 4 contracted pinworms. Staff identified it with one child and informed the parents who took the child to the doctor where it was officially diagnosed. The child stayed home and was treated with the required medication before returning, but five other children were also diagnosed with pinworms. The outbreak was contained in Spaces 2 and 3 that serve toddlers. The center washed all linens daily and sent blankets and comfort items home. While they cleaned and disinfected daily, the new owner closed the center for a deep clean on the Thursday before the long Memorial Day Weekend. They removed rugs and soft toys, disinfected all surfaces and materials and had a pest control company spray the playground several times. The new owner bought new brooms and mops. There have been no diagnoses of pinworms since Thursday, May 23, 2024. My Observations: I received a Sanitation Inspection dated 5/21/2024 which reflected that the facility received 18 demerits and an Approved classification. Demerits were taken for handwashing procedures including improper handwashing, not handwashing after returning from the playground, a broken handwash sink, and a handwash sink not tempered at 80 – 110 degrees ( a temperature range warm enough to kill germs with proper soap and handwashing procedures.) In addition, demerits were taken for improper diaper changing procedures as well as improper cleaning and disinfecting of the diaper table between diaper changes. Today, I observed multiple instances of staff and child handwashing and diaper changing. Handwashing was completed as required and followed the required steps. With toddlers and two’s, it still requires a lot of reminders and assistance, but children were handwashing correctly. Staff who completed diapering used a wipe in between removing of the dirty diaper and cleaning the bottom and placing a clean diaper on the child. Diaper changing tables were cleaned and disinfected as required. Children and staff washed hands. Based upon your statements and my observations, this allegation is confirmed; however, with technical assistance from the Environmental Health Inspector and the Administrator, it appears that the center is now following proper sanitation procedures to reduce the spread of communicable disease. The following item was documented as a violation during today’s visit: Violation Number Comment Rule 875 The center did not follow all procedures to prevent the spread of communicable diseases described in 15A NCAC 18A .2800. Staff did not follow required handwashing and diapering procedures. 10A NCAC 09 .0804(b)(1) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and emailed a copy of it to E. Oppong, Administrator. There was one violation that has been corrected so no further action is needed except to be vigilant with center sanitation procedures. Please respond to the email saying that you have received the visit summary. If you need further assistance or have questions, do not hesitate to contact me. Feel free to contact me by phone at (252) 373-9385 or by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199. Technical Assistance with Documented Violations: #875: Prevention of Communicable Diseases – Proper handwashing, diaper changing procedures, and sanitation procedures help to prevent the spread of communicable diseases and parasites, keeping children and staff healthy. During a Sanitation Inspection on 5/21/2024, children were observed not washing their hands properly and not washing their hands when returning indoors from the playground and before touching classroom materials. Work with staff to help children follow steps for handwashing at times required. There are handwashing posters at every hand wash sink describing proper handwashing procedures. Monitor handwashing by children and staff closely and provide staff with feedback for improvement. Provide 20-second sand timers that children can use as a visual for the amount of time required for adequate handwashing and teach children handwashing songs The Environmental Health Inspector also noted that one sink in the preschool area was out of service and the sink in Space 4 for children, one and two years of age, did not have tempered water between 80 and 110 degrees. These need to be fixed to ensure proper handwashing can occur. Note that all sinks are required to have soap and paper towels available for handwashing with running water tempered between 80 and 110 degrees. Repair any sinks that are not working or maintaining the correct temperature. During the sanitation inspection, teachers were observed not following required steps for diaper changing, leaving out the middle steps of wiping their hands and the child’s hands with a clean diaper wipe for each after removing the dirty diaper and cleaning the child’s soiled bottom and before placing a clean diaper on the child. Teach staff to follow the procedures for diaper changing as described on the diaper changing posters at every diaper station. During the sanitation inspection, a staff member was observed wiping the diaper changing table with a rag right after spraying with disinfectant instead of waiting at least two minutes and using a clean paper towel. Again, provide each diaper changing station with a two-minute timer so that staff can ensure that the disinfectant sits on the surface long enough to kill germs. The administrator stated that she has continued to work with staff on sanitation procedures and will continue to monitor and provide feedback. Failure to follow basic sanitation procedures leads to the spread of germs and may have resulted in the spread of pinworms in the center in April and May. Stacy Rosser is a Child Care Health Consultant assigned to work with facilities in Dare County. Invite her to offer staff training and technical assistant on sanitation procedures such as handwashing, diaper changing, and how to clean and sanitize or disinfect contaminated surfaces. You can reach her at Office: (252) 557-4208 or stacy_rosser@unc.edu. Compliance History: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 12/1/22 – 5/31/24 = 83%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to section labeled Technical Assistance, for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0524-368L Visit Date: 6/4/2024 Number Present: 19 Completed Date: 6/4/2024 Age: From 0 To 5 Total Minutes: 75 Time In: 02:30 PM Time Out: 03:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding an alleged violation of child care requirements. The allegation is as follows: There is a concern regarding sanitation guidelines. E. Oppong, Administrator, was not present, but S. Morris, Lead Floater, assisted me with a walk-through of the center. I completed limited monitoring of child care requirements during the visit. Supervision of children, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. I observed a staff/child ratio violation but documented it on the Routine Unannounced visit competed in conjunction with this Complaint visit. I received information regarding the allegation from a collaborative partner prior to the visit. Investigation: The allegations were shared with the administrator over the phone and one staff member. Additional information was provided by a collaborative partner before the visit. Allegation #1: There is a concern regarding sanitation guidelines. Your Responses: Staff stated that several children in Spaces 3 and 4 contracted pinworms. Staff identified it with one child and informed the parents who took the child to the doctor where it was officially diagnosed. The child stayed home and was treated with the required medication before returning, but five other children were also diagnosed with pinworms. The outbreak was contained in Spaces 2 and 3 that serve toddlers. The center washed all linens daily and sent blankets and comfort items home. While they cleaned and disinfected daily, the new owner closed the center for a deep clean on the Thursday before the long Memorial Day Weekend. They removed rugs and soft toys, disinfected all surfaces and materials and had a pest control company spray the playground several times. The new owner bought new brooms and mops. There have been no diagnoses of pinworms since Thursday, May 23, 2024. My Observations: I received a Sanitation Inspection dated 5/21/2024 which reflected that the facility received 18 demerits and an Approved classification. Demerits were taken for handwashing procedures including improper handwashing, not handwashing after returning from the playground, a broken handwash sink, and a handwash sink not tempered at 80 – 110 degrees ( a temperature range warm enough to kill germs with proper soap and handwashing procedures.) In addition, demerits were taken for improper diaper changing procedures as well as improper cleaning and disinfecting of the diaper table between diaper changes. Today, I observed multiple instances of staff and child handwashing and diaper changing. Handwashing was completed as required and followed the required steps. With toddlers and two’s, it still requires a lot of reminders and assistance, but children were handwashing correctly. Staff who completed diapering used a wipe in between removing of the dirty diaper and cleaning the bottom and placing a clean diaper on the child. Diaper changing tables were cleaned and disinfected as required. Children and staff washed hands. Based upon your statements and my observations, this allegation is confirmed; however, with technical assistance from the Environmental Health Inspector and the Administrator, it appears that the center is now following proper sanitation procedures to reduce the spread of communicable disease. The following item was documented as a violation during today’s visit: Violation Number Comment Rule 875 The center did not follow all procedures to prevent the spread of communicable diseases described in 15A NCAC 18A .2800. Staff did not follow required handwashing and diapering procedures. 10A NCAC 09 .0804(b)(1) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and emailed a copy of it to E. Oppong, Administrator. There was one violation that has been corrected so no further action is needed except to be vigilant with center sanitation procedures. Please respond to the email saying that you have received the visit summary. If you need further assistance or have questions, do not hesitate to contact me. Feel free to contact me by phone at (252) 373-9385 or by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199. Technical Assistance with Documented Violations: #875: Prevention of Communicable Diseases – Proper handwashing, diaper changing procedures, and sanitation procedures help to prevent the spread of communicable diseases and parasites, keeping children and staff healthy. During a Sanitation Inspection on 5/21/2024, children were observed not washing their hands properly and not washing their hands when returning indoors from the playground and before touching classroom materials. Work with staff to help children follow steps for handwashing at times required. There are handwashing posters at every hand wash sink describing proper handwashing procedures. Monitor handwashing by children and staff closely and provide staff with feedback for improvement. Provide 20-second sand timers that children can use as a visual for the amount of time required for adequate handwashing and teach children handwashing songs The Environmental Health Inspector also noted that one sink in the preschool area was out of service and the sink in Space 4 for children, one and two years of age, did not have tempered water between 80 and 110 degrees. These need to be fixed to ensure proper handwashing can occur. Note that all sinks are required to have soap and paper towels available for handwashing with running water tempered between 80 and 110 degrees. Repair any sinks that are not working or maintaining the correct temperature. During the sanitation inspection, teachers were observed not following required steps for diaper changing, leaving out the middle steps of wiping their hands and the child’s hands with a clean diaper wipe for each after removing the dirty diaper and cleaning the child’s soiled bottom and before placing a clean diaper on the child. Teach staff to follow the procedures for diaper changing as described on the diaper changing posters at every diaper station. During the sanitation inspection, a staff member was observed wiping the diaper changing table with a rag right after spraying with disinfectant instead of waiting at least two minutes and using a clean paper towel. Again, provide each diaper changing station with a two-minute timer so that staff can ensure that the disinfectant sits on the surface long enough to kill germs. The administrator stated that she has continued to work with staff on sanitation procedures and will continue to monitor and provide feedback. Failure to follow basic sanitation procedures leads to the spread of germs and may have resulted in the spread of pinworms in the center in April and May. Stacy Rosser is a Child Care Health Consultant assigned to work with facilities in Dare County. Invite her to offer staff training and technical assistant on sanitation procedures such as handwashing, diaper changing, and how to clean and sanitize or disinfect contaminated surfaces. You can reach her at Office: (252) 557-4208 or stacy_rosser@unc.edu. Compliance History: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 12/1/22 – 5/31/24 = 83%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to section labeled Technical Assistance, for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 12/19/2023 Number Present: 14 Completed Date: 12/19/2023 Age: From 0 To 4 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements and continue discussions for the child care center’s rated license reassessment. Last Annual Compliance visit – 2/14/23 Last Sanitation Inspection – 12/13/23 with a Superior Rating; expires 12/13/24 Last Fire Inspection – 10/23/23 with Satisfactory rating; approved for daytime only *Sanitation and fire inspections are required at least annually by the date of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. 18-month compliance history from 6/19/22 – 12/18/23 = 87% The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/21. See below for more information about the Division’s plan to return to rated license assessments. This facility is owned by Healthy Environments Child Development Center Kdhnc LLC. According to the NC Secretary of State's website, this corporation is current and active as of 12/17/23. Please contact me prior to any information change regarding the ownership of this facility. License information was current. Contact me to make any changes to address, phone, or email or to request changes to the license. You have hired a new On-Site Assistant Administrator. She completed an Administrator Preservice Form and you signed it. I monitored the classrooms and spaces used for child care, kitchen, and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 7/1/2023 and Item Number Listing, effective 8/2023. I monitored two children’s records, nine staff records and all program records. The facility does not offer transportation. Center Observations: The facility was decorated for Christmas. Parent information was posted at the entrance along with the daily attendance sheet reflecting arrival and departure. Parents also check in and out on Brightwheel, and teachers document classroom arrival and departure times. All groups were participating in indoor free play with materials in defined activity centers. It was cold outdoors, but everyone older than the infants wrapped up and went outdoors where they had access to portable gross motor toys and make believe materials. When they returned indoors, they used the bathroom or were diapered and washed hands. Lunches were brought from home. Lunches observed met nutritional requirements. Children sat at child-sized tables, and teachers sat with them to provide close supervision and interactions. Later the older children slept on linen-covered cots. The one infant and one toddler present in Space 2 were cared for on their own schedule. Documentation of safe sleep checks was available and current. Feeding plans were posted, but one had not been updated to reflect the addition of table food to the infant’s feeding plan. Interactions were warm and nurturing. I spent time today reviewing children’s records and staff records with the new assistant administrator. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. Five rubber handlebar covers were missing from four tricycles on the playground creating a sharp edge and potential habitat from spiders and wasps. .0601(c) 808 The outdoor premises were not clean, drained and free of litter and hazardous materials grass and other vegetation in a manner which does not encourage vermin. Weeds with sharp thorns were growing along the fence, creating a habitat for pests and sharp thorns that could scratch or puncture children. 15A NCAC 18A .2832(a) 847 Parent's medication authorization did not include required information. Three medication permission forms for diaper creams were expired or did not include the required information. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. Documentation of monthly outdoor inspections was not available for July 2023, September 2023, October 2023, and November 2023. .0605(q) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. The Emergency Medical Care Plan was not updated to reflect current staff and was not reviewed with staff in September 2023. 10A NCAC 09 .0802(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. A staff member was due for First Aid recertification by May 31, 2023 but did not complete First Aid until October 21, 2023. .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. A staff member was due for CPR recertification by May 31, 2023 but did not complete CPR until October 21, 2023. .1102(d) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The current EPR Plan was reviewed and updated in the Emergency Management Portal in February 2023, but the updated EPR Plan was not printed and reviewed with staff. .0607(e) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to S. Morris, authorized by L. Jones-Hoats to sign for today’s visit summary in her absence. We reviewed the visit summary and violation(s) documented during today’s visit. Correct these immediately. Send evidence of correction to me so that I receive it no later than 1/2/2024. The compliance verification letter needs to state the facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. If referring to staff or children in your compliance letter, refer to them by initials or position. Also include the following documents/pictures to verify compliance: copy of December Outdoor Inspection, updated copy of Emergency Medical Care Plan, updated copy of EPR Plan Send compliance verification letter in an email from the center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. If sent from another email address, the center’s official address must be Cc’d in the compliance email. You may include the compliance verification as an attachment or in the body of the email. If sufficient information is not received by the due date, a follow-up visit may be conducted. *I will email a sample compliance verification letter to you. *Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. Technical Assistance With Documented Violations: Playground Equipment – Ensuring that indoor and outdoor equipment is free from potential hazards provides a safe play space for children to freely use equipment to develop their gross motor skills. Several of the tricycles on the playground are missing rubber handles on the handle bars that protect the children from injury if they run into the handlebars and keep wasp or spiders from taking up residence in the hollow tubes of the handle bars. It is possible that you missed this because an outdoor inspection has not been completed since August 2023. Replace the rubber handle bar covers. Have all staff take Playground Safety Training so everyone can identify playground hazards and inform you when toys and equipment need maintenance or need to be removed. For your compliance letter, state that date when the handlebars on the tricycles have new rubber handlebar covers. Overgrowth and Debris on Playgrounds – Grass, weeds, and overgrowth along the inside and outside of fences must be maintained and cut back to prevent vermin and outdoor creatures from setting up residency or making themselves less visible. Vegetation that is potentially toxic or has sharp thorns also needs to be cut back. There are weeds growing along, over, and through the fence that have very sharp thorns and could scratch children. It is possible that you missed this because an outdoor inspection has not been completed since August 2023. Daily outdoor checks for trash, overgrowth, broken equipment, etc. are required daily. More extensive outdoor inspections are required to be completed and documented monthly. Cut back the weeds immediately. Consider clearing out two feet on the outside of the fence to better maintain vegetative growth at the fence. For your compliance letter, state the date the weeds along the fence line are removed. Medication Permission Forms - All medications for children present at the center must have a current, completed medication permission form even if there is a Medical Action Plan. The medication permission forms provide additional information that could be critical to the administration of the medication and the care of the child. The following medication forms in Space 5 (2’s and 3’s) did not include required information. 1. A&D Ointment for MV – authorized for 9/12/22 – 9/12/23 – authorization expired 2. Two forms for Boudreaux’s Butt Paste for HS – one authorized for 8/29/22 – 8/29/23 – authorization expired; the other was incomplete and did not include a 12-month authorization period, amount of diaper cream to be administered and when to administer diaper cream. Also include full name of child on form. Also label medications with children’s names or at least initials. Keep a sharpie handy. Because of the administrator turnover, medication boxes have not been monitored. Medication permission forms for OTC, prescription, and emergency medication have an administration log as part of the form. This must be completed any time the medication is given. Update the medication permission forms or return the medication to families. Also review all medication and medication permission forms to ensure they are current and complete. For your compliance letter, state the date all medication and medication permission forms are up-to-date or returned to families. Outdoor Inspections and Playground Safety Training - Regular outdoor inspections are critical to prevent deterioration of equipment and accumulation of hazardous materials within the play site, and to ensure that appropriate repairs are made as soon as possible. A monthly safety check of all the equipment within the facility as a focused task provides an opportunity to notice wear and tear that requires maintenance. Documentation of monthly outdoor inspections was not available for July 2023, September 2023, October 2023, and November 2023. You stated due to the change in on-site administration since the spring, outdoor inspections have been overlooked. Monthly inspections of the outdoor play area are required to be completed by a designated staff member with Playground Safety Training. L. Jones-Hoats and L. Rock are the only center staff with Playground Safety Training, so they need to complete monthly outdoor inspections. The new assistant administrator should consider completing Playground Safety Training so that she can assist with those responsibilities. For your compliance letter, complete and document an Outdoor Inspection for December and describe how you will ensure they are completed monthly. In addition to your compliance letter, scan and include a copy of the December outdoor inspection. Emergency Medical Care Plan (EMCP) – Updating the Emergency Medical Care Plan when there are staff changes and reviewing it with staff as changes occur or at least annually ensures that all staff know their role in a staff or medical emergency. The posted EMCP has a previous administrator listed and has not been updated. In addition, the EMCP was not reviewed with staff in September 2023. Update and post the Emergency Medical Care Plan. Review with staff when they return in January 2024. For your compliance letter, state the date the EMCP is updated and the date it is reviewed with staff. Also send a copy of the updated Emergency Medical Care Plan. First Aid and CPR – Early care and education programs with staff trained in pediatric first aid and CPR can mitigate the consequences of injury and reduce the potential for death from life-threatening conditions and emergencies. Repetitive training, coupled with the confidence to use these skills, are critically important to the outcome of an emergency. (Caring for Our Children, 4th Edition). K. Pegues was due to recertify First Aid and CPR by 5/31/2023 but did not complete the training until 10/21/2023. You stated that the administrator who worked during the spring and summer of 2023 overlooked the need for CPR/First Aid training. By reviewing and updating staff worksheets at least monthly, you can track expiration dates for trainings, criminal background checks and annual forms. This has been corrected. No further action or documentation in required except to maintain current First Aid and CPR in the future. Repeated CPR/First Aid violations may result in an Administrative Action. *New staff need to complete First Aid and CPR within three months of hire. See Row 19 on your staff worksheet to see who needs First Aid and CPR training. Consider having a class for all of them before the first one is due on 2/29/2024. Emergency Preparedness and Response (EPR) Requirements – Reviewing and updating your EPR Plan ensures that emergency procedures are current based on your enrollment, staff, and new recommendations for lock downs, shelter-in-place, or evacuations. You last updated your EPR Plan in February 2023 but did not print out an updated copy or at least a new cover sheet and Page 28 reflecting the date of your review and updates. *Log into the Emergency Management Portal on the DCDEE website -> Provider tab -> Emergency Preparedness and Response -> Emergency Management Portal -> Log in using NCID used to create or update EPR Plan. Review the EPR Plan and update as needed. Document review date on page 28. If changes are needed, print plan up to page 29. If no changes are needed, print pages 1 and 28 with review date reflected. Review updated EPR Plan with staff and during orientation with new staff. Use this time to also review and update Emergency Medical Care Plan and review with staff also. * If you have questions, or need assistance with accessing your EPR Plan contact Amia M. Eaton, Training and Program Development Consultant Amia.Eaton@dhhs.nc.gov *For your compliance letter, state the date your EPR Plan is updated and attach a copy of the plan in the email with your compliance letter. General Visit Information: Be knowledgeable of the child care laws and rules and environmental health rules; review them with your staff and assist them with understanding and implementing them to maintain compliance and keep children safe and healthy. The most recent versions of child care laws and rules (updated 7/1/23) and environmental health rules (updated 7/1/23) in North Carolina, the Items Number Listing (can be used as a detailed checklist of required items) and What’s New information are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies are available to assist you with technical assistance and training on a multitude of topics including but not limited to: Environment Rating Scales, infant/toddler practices, healthy behaviors and classroom management, developmentally appropriate practice, EPR plans, activity plans, NC Foundations for Early Learning (developmental domains), etc. Child Care Health Consultants can provide training and technical assistance on topics related to health and safety such as sanitation, handwashing, diapering, illness policies, etc. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. -> Dare County has a new CCHC! *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone (252) 333-1233; website - www.aacfnc.org . Reminders: Children’s Records – Children’s records were complete. Consider adding the wording for the Health Care Needs Section of the DCDEE Child’s Application for Enrollment verbatim to include the question, “Does your child have a Medical Action Plan?” Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. *We reviewed your staff worksheet. I highlighted items that were delinquent and items that are coming due in the next year. Health and Safety Training and Five (5) Year Cycle Tracking Requirements – Review Row 17 on Staff Worksheet for staff members needing initial H&S Training or five-year renewal. New staff are required to complete Health & Safety Training (H&S Training) within one year of hire (CPR/First Aid and Recognizing and Responding to Suspicions of Child Maltreatment within 3 months of hire) and then complete training in all topic areas every five years. *Free H&S Training available on Moodle and Prevent Child Abuse NC website. See Additional Comments for information on Moodle Support. On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours L. Rock will need by 2/14/24 (anniversary of last Annual Compliance visit) New staff will complete Health & Safety in their first year and then will complete on-going training annually based upon their level of education posted in DCDEE Works. *If staff have not met the required on-going training hours that are due by 2/14/24, I will review at the next visit. Staff need to complete the On-going Training Log and attach certificates. Activity Plans – Activity plans are essential to planning and preparing for children’s activities throughout the week and can make or break the flow of the classroom. Well-planned, intentional activities keep children engaged with less time for challenging behaviors. Date weekly activity plans and post where they are visible to parents. Include both free choice and teacher-directed activities, that allow children to choose to participate with the whole group, in a small group or independently. Listed activities must stimulate the following 5 developmental domains each day, as listed in the NC Foundations for Early Learning and Development book: social & emotional development (ESD), health & physical development (HPD), approaches to play and learning (APL), language development & communication (LDC), and cognitive development (CD). Plan for at least 4 activities daily, one of which must be a planned gross motor activity which may occur indoors or outdoors. The remaining 3 activities should occur in the following areas (art, books, blocks, manipulatives and dramatic play). In addition, plan for these 3 enrichment activities on at least a weekly basis: sand or water play; science and nature; and music and rhythm. Many teachers include these items daily also. To smoothly implement the daily activity plan, have materials and equipment available both inside and outside to support the activities listed. Nutrition – The two children’s files I reviewed did not include a Nutrition Opt-out form. The lunches observed met nutritional requirements but consider having all parents complete this form at enrollment so that you do not have to supplement meals if they are missing any food components. Diapering – Work with staff on the fine points of diapering. Need to remove gloves once the soiled diaper is removed and the bottom is wiped. Then use a wipe to clean adult hands and a wipe to clean child’s hands before putting on clean diaper. Contact S. Rosser, Child Care Health Consultant, to provide technical assistance with new staff. Additional Comments: Medicaid Expansion – Share with your staff! - Studies show that at least 25% of people working in child care in North Carolina do not have health insurance. Starting 12/1/2023, more North Carolinians can now get health coverage through Medicaid even if they haven’t qualified before. Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health services and more – at little or no cost to beneficiaries. Most people can get health care coverage through Medicaid if they meet the criteria below. • Live in North Carolina • Age 19 through 64 • Are a citizen. Some non-U.S. citizens can get health care coverage through Medicaid. • Have a household income that is below 138% of the federal poverty level. That’s about $20,000 for a single adult or about $34,000 for a family of three. If you were eligible for Medicaid prior to Dec 1, 2023, you still are. To learn more, go to Medicaid.nc.gov. Annual License Fee - There are a few changes to the Annual License Fee process this year: • All invoices will be emailed, and no paper copies will be sent through the U.S. Postal Service. • All invoices will be emailed by December 1, 2023 and will include the invoice number and total amount due. • All payments are due no later than December 31, 2023 Payments must be submitted online only through the Division’s website using a Mastercard or Visa debit or credit card, or by e-check. Providers will need their Facility ID number and their 2023 Invoice number to complete the payment process. If you have any questions, check the short Frequently Asked Questions on our website for answers or email DCDEE_LF@dhhs.nc.gov . I shared information on the following topics and emailed the information to you after the visit: 1. Free On-line Teacher Professional Development Memberships 2. How is it Going? We Want to Hear from You! 3. Unpacking ITERS-R: An Overview of the Infant/Toddler Environment Rating Scale 4. Clean Classrooms for Carolina Kids – required testing for lead in water, lead paint, asbestos 5. Resources from Health and Safety Resource Center! 6. Environmental Health Rules Update 7. Moodle Support Email and Phone Contact 8. NC Early Childhood Credential (NCECC) Equivalency Exam - Available on Moodle! 9. Challenging Behaviors Helpline! 10. Military Child Care in Your Neighborhood-Plus (MCCYN-PLUS) 11. NC Rated License Assessment Project (NCRLAP) Resources 12. NCID – Keep it active! Transition Back To Rated License Assessments And Cohorts To transition back to rated license assessments, the Division has created a two-year Cohort Model. All facilities are assigned to one of three cohorts based on their current rated license assessment due date. Each cohort will have a year for preparation and a year for assessment. (However, you are encouraged to begin preparations now so that you are ready when your cohort group is due!) Your child care center was due for a three-year rated license reassessment on 8/6/2021 and has been assigned to Cohort 1. The Cohort 1 Rated License Preparation Year is from 7/1/2023 – 6/30/2024. You are now halfway through your preparation year. During your preparation year, if you are interested in having the Environment Rating Scales completed, review the ITERS-R and ECERS-R by obtaining the manuals for each classroom and looking for assessment related resources at ncrlap.org. Request technical assistance and training for your staff from Children & Youth Partnership for Dare County. You can request and complete an ITERS-R and ECERS-R during your preparation year. If your scores help you meet or exceed your current star rating and you are ready to move forward with your rated license assessment, you may choose to do so during your preparation year. Your preparation year is also the time to continue to work on staff education and ensure that Works accounts are completed and up to date for staff members. Look at options to help staff earn the NC Early Childhood Credential (NCECC): completing EDU 119 at one of the NC Community Colleges, applying for Early Educator Certification through the NC Institute for Child Development Professionals, completing and passing the new NCECC Equivalency Exam option available on Moodle, or earning the Child Development Associate (CDA). Encourage staff with the NCECC to enroll in additional college coursework to increase points in Education. TEACH Scholarships are available to help staff pay for educational expenses. Go to https://www.childcareservices.org/programs/teach-north-carolina/ The Cohort 1 Rated License Assessment Year is from 7/1/2024 – 6/30/2025. During your assessment year you may choose to complete the ITERS-R and ECERS-R again at no cost even if you completed them during your preparation year. Use the feedback from your preparation year scores to create a plan to improve your scores. During this year, all education needs to be posted in Works. At some point during that year (based on the date of your Annual Compliance visit), you will have your rated license assessed. Update On Center’s Rated License Points: Program Standards – Currently Two (2) Points *will be reassessed if ITERS-R and ECERS-R are completed *meets enhanced space; will need to meet enhanced ratios to earn 3 points or higher Education Standards – Last Rated License - Four (4) Points – currently eligible for One (1) Point *Based in information available in DCDEE Works *Points are earned based on the lowest level of education for any one position. Administrator Education – 7 Points L. Jones-Hoats – NCECAC III w/ 36+y ec and ad exp = 7 points Lead Teacher Education – 7 Points: Currently eligible for 7 Points *SB 570 providing flexibility to allow 50% of lead teachers have AAS-ECE or higher at 7 Point level until 6/2023 Space 2 (Infants & 1’s) L. Rock – NCECC + 19 ECE w/ 18y exp = 5 points Space 3 (1’s & 2’s) B. Power Space 4 (not in use) Space 5 (2’s & 3’s) K. Pegues – sub Space 1 (3’s – 5’s) K. Petersen *Apply for Early Educator Certification to earn 7 points. (See below.) Early Educator Certification (EEC) is another option to earn education points for the rated license. To apply for Early Educator Certification, go to the website for the NC Institute for Child Development Professionals https://ncicdp.org/ 1. On the left, click on Certifications and Endorsements 2. Slide to the right to Early Educator Certification (EEC) Forms and Endorsements 3. Read the information and follow the instructions to apply. 4. Mail completed application, original, official transcripts (may be opened), and $50 application fee to NCICDP. 5. Once a certificate or letter verifying the award of the certificate is received, log into Works account and upload the EEC Certificate or Letter. EEC will expire, but it counts towards rated license points indefinitely if it is current when posted in Works. Quality Point - One (1) Point The center meets the following Education Options: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. Total the amount of points in Program Standards, Education Standards and Quality Point. 1 – 3 Points = One Star 4 – 6 Points = Two Stars 7 – 9 Points = Three Stars (required to accept subsidy) 10 – 12 Points = Four Stars 13 – 15 Points = Five Stars Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 12/19/2023 Number Present: 14 Completed Date: 12/19/2023 Age: From 0 To 4 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements and continue discussions for the child care center’s rated license reassessment. Last Annual Compliance visit – 2/14/23 Last Sanitation Inspection – 12/13/23 with a Superior Rating; expires 12/13/24 Last Fire Inspection – 10/23/23 with Satisfactory rating; approved for daytime only *Sanitation and fire inspections are required at least annually by the date of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. 18-month compliance history from 6/19/22 – 12/18/23 = 87% The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/21. See below for more information about the Division’s plan to return to rated license assessments. This facility is owned by Healthy Environments Child Development Center Kdhnc LLC. According to the NC Secretary of State's website, this corporation is current and active as of 12/17/23. Please contact me prior to any information change regarding the ownership of this facility. License information was current. Contact me to make any changes to address, phone, or email or to request changes to the license. You have hired a new On-Site Assistant Administrator. She completed an Administrator Preservice Form and you signed it. I monitored the classrooms and spaces used for child care, kitchen, and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 7/1/2023 and Item Number Listing, effective 8/2023. I monitored two children’s records, nine staff records and all program records. The facility does not offer transportation. Center Observations: The facility was decorated for Christmas. Parent information was posted at the entrance along with the daily attendance sheet reflecting arrival and departure. Parents also check in and out on Brightwheel, and teachers document classroom arrival and departure times. All groups were participating in indoor free play with materials in defined activity centers. It was cold outdoors, but everyone older than the infants wrapped up and went outdoors where they had access to portable gross motor toys and make believe materials. When they returned indoors, they used the bathroom or were diapered and washed hands. Lunches were brought from home. Lunches observed met nutritional requirements. Children sat at child-sized tables, and teachers sat with them to provide close supervision and interactions. Later the older children slept on linen-covered cots. The one infant and one toddler present in Space 2 were cared for on their own schedule. Documentation of safe sleep checks was available and current. Feeding plans were posted, but one had not been updated to reflect the addition of table food to the infant’s feeding plan. Interactions were warm and nurturing. I spent time today reviewing children’s records and staff records with the new assistant administrator. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. Five rubber handlebar covers were missing from four tricycles on the playground creating a sharp edge and potential habitat from spiders and wasps. .0601(c) 808 The outdoor premises were not clean, drained and free of litter and hazardous materials grass and other vegetation in a manner which does not encourage vermin. Weeds with sharp thorns were growing along the fence, creating a habitat for pests and sharp thorns that could scratch or puncture children. 15A NCAC 18A .2832(a) 847 Parent's medication authorization did not include required information. Three medication permission forms for diaper creams were expired or did not include the required information. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. Documentation of monthly outdoor inspections was not available for July 2023, September 2023, October 2023, and November 2023. .0605(q) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. The Emergency Medical Care Plan was not updated to reflect current staff and was not reviewed with staff in September 2023. 10A NCAC 09 .0802(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. A staff member was due for First Aid recertification by May 31, 2023 but did not complete First Aid until October 21, 2023. .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. A staff member was due for CPR recertification by May 31, 2023 but did not complete CPR until October 21, 2023. .1102(d) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The current EPR Plan was reviewed and updated in the Emergency Management Portal in February 2023, but the updated EPR Plan was not printed and reviewed with staff. .0607(e) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to S. Morris, authorized by L. Jones-Hoats to sign for today’s visit summary in her absence. We reviewed the visit summary and violation(s) documented during today’s visit. Correct these immediately. Send evidence of correction to me so that I receive it no later than 1/2/2024. The compliance verification letter needs to state the facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. If referring to staff or children in your compliance letter, refer to them by initials or position. Also include the following documents/pictures to verify compliance: copy of December Outdoor Inspection, updated copy of Emergency Medical Care Plan, updated copy of EPR Plan Send compliance verification letter in an email from the center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. If sent from another email address, the center’s official address must be Cc’d in the compliance email. You may include the compliance verification as an attachment or in the body of the email. If sufficient information is not received by the due date, a follow-up visit may be conducted. *I will email a sample compliance verification letter to you. *Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. Technical Assistance With Documented Violations: Playground Equipment – Ensuring that indoor and outdoor equipment is free from potential hazards provides a safe play space for children to freely use equipment to develop their gross motor skills. Several of the tricycles on the playground are missing rubber handles on the handle bars that protect the children from injury if they run into the handlebars and keep wasp or spiders from taking up residence in the hollow tubes of the handle bars. It is possible that you missed this because an outdoor inspection has not been completed since August 2023. Replace the rubber handle bar covers. Have all staff take Playground Safety Training so everyone can identify playground hazards and inform you when toys and equipment need maintenance or need to be removed. For your compliance letter, state that date when the handlebars on the tricycles have new rubber handlebar covers. Overgrowth and Debris on Playgrounds – Grass, weeds, and overgrowth along the inside and outside of fences must be maintained and cut back to prevent vermin and outdoor creatures from setting up residency or making themselves less visible. Vegetation that is potentially toxic or has sharp thorns also needs to be cut back. There are weeds growing along, over, and through the fence that have very sharp thorns and could scratch children. It is possible that you missed this because an outdoor inspection has not been completed since August 2023. Daily outdoor checks for trash, overgrowth, broken equipment, etc. are required daily. More extensive outdoor inspections are required to be completed and documented monthly. Cut back the weeds immediately. Consider clearing out two feet on the outside of the fence to better maintain vegetative growth at the fence. For your compliance letter, state the date the weeds along the fence line are removed. Medication Permission Forms - All medications for children present at the center must have a current, completed medication permission form even if there is a Medical Action Plan. The medication permission forms provide additional information that could be critical to the administration of the medication and the care of the child. The following medication forms in Space 5 (2’s and 3’s) did not include required information. 1. A&D Ointment for MV – authorized for 9/12/22 – 9/12/23 – authorization expired 2. Two forms for Boudreaux’s Butt Paste for HS – one authorized for 8/29/22 – 8/29/23 – authorization expired; the other was incomplete and did not include a 12-month authorization period, amount of diaper cream to be administered and when to administer diaper cream. Also include full name of child on form. Also label medications with children’s names or at least initials. Keep a sharpie handy. Because of the administrator turnover, medication boxes have not been monitored. Medication permission forms for OTC, prescription, and emergency medication have an administration log as part of the form. This must be completed any time the medication is given. Update the medication permission forms or return the medication to families. Also review all medication and medication permission forms to ensure they are current and complete. For your compliance letter, state the date all medication and medication permission forms are up-to-date or returned to families. Outdoor Inspections and Playground Safety Training - Regular outdoor inspections are critical to prevent deterioration of equipment and accumulation of hazardous materials within the play site, and to ensure that appropriate repairs are made as soon as possible. A monthly safety check of all the equipment within the facility as a focused task provides an opportunity to notice wear and tear that requires maintenance. Documentation of monthly outdoor inspections was not available for July 2023, September 2023, October 2023, and November 2023. You stated due to the change in on-site administration since the spring, outdoor inspections have been overlooked. Monthly inspections of the outdoor play area are required to be completed by a designated staff member with Playground Safety Training. L. Jones-Hoats and L. Rock are the only center staff with Playground Safety Training, so they need to complete monthly outdoor inspections. The new assistant administrator should consider completing Playground Safety Training so that she can assist with those responsibilities. For your compliance letter, complete and document an Outdoor Inspection for December and describe how you will ensure they are completed monthly. In addition to your compliance letter, scan and include a copy of the December outdoor inspection. Emergency Medical Care Plan (EMCP) – Updating the Emergency Medical Care Plan when there are staff changes and reviewing it with staff as changes occur or at least annually ensures that all staff know their role in a staff or medical emergency. The posted EMCP has a previous administrator listed and has not been updated. In addition, the EMCP was not reviewed with staff in September 2023. Update and post the Emergency Medical Care Plan. Review with staff when they return in January 2024. For your compliance letter, state the date the EMCP is updated and the date it is reviewed with staff. Also send a copy of the updated Emergency Medical Care Plan. First Aid and CPR – Early care and education programs with staff trained in pediatric first aid and CPR can mitigate the consequences of injury and reduce the potential for death from life-threatening conditions and emergencies. Repetitive training, coupled with the confidence to use these skills, are critically important to the outcome of an emergency. (Caring for Our Children, 4th Edition). K. Pegues was due to recertify First Aid and CPR by 5/31/2023 but did not complete the training until 10/21/2023. You stated that the administrator who worked during the spring and summer of 2023 overlooked the need for CPR/First Aid training. By reviewing and updating staff worksheets at least monthly, you can track expiration dates for trainings, criminal background checks and annual forms. This has been corrected. No further action or documentation in required except to maintain current First Aid and CPR in the future. Repeated CPR/First Aid violations may result in an Administrative Action. *New staff need to complete First Aid and CPR within three months of hire. See Row 19 on your staff worksheet to see who needs First Aid and CPR training. Consider having a class for all of them before the first one is due on 2/29/2024. Emergency Preparedness and Response (EPR) Requirements – Reviewing and updating your EPR Plan ensures that emergency procedures are current based on your enrollment, staff, and new recommendations for lock downs, shelter-in-place, or evacuations. You last updated your EPR Plan in February 2023 but did not print out an updated copy or at least a new cover sheet and Page 28 reflecting the date of your review and updates. *Log into the Emergency Management Portal on the DCDEE website -> Provider tab -> Emergency Preparedness and Response -> Emergency Management Portal -> Log in using NCID used to create or update EPR Plan. Review the EPR Plan and update as needed. Document review date on page 28. If changes are needed, print plan up to page 29. If no changes are needed, print pages 1 and 28 with review date reflected. Review updated EPR Plan with staff and during orientation with new staff. Use this time to also review and update Emergency Medical Care Plan and review with staff also. * If you have questions, or need assistance with accessing your EPR Plan contact Amia M. Eaton, Training and Program Development Consultant Amia.Eaton@dhhs.nc.gov *For your compliance letter, state the date your EPR Plan is updated and attach a copy of the plan in the email with your compliance letter. General Visit Information: Be knowledgeable of the child care laws and rules and environmental health rules; review them with your staff and assist them with understanding and implementing them to maintain compliance and keep children safe and healthy. The most recent versions of child care laws and rules (updated 7/1/23) and environmental health rules (updated 7/1/23) in North Carolina, the Items Number Listing (can be used as a detailed checklist of required items) and What’s New information are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies are available to assist you with technical assistance and training on a multitude of topics including but not limited to: Environment Rating Scales, infant/toddler practices, healthy behaviors and classroom management, developmentally appropriate practice, EPR plans, activity plans, NC Foundations for Early Learning (developmental domains), etc. Child Care Health Consultants can provide training and technical assistance on topics related to health and safety such as sanitation, handwashing, diapering, illness policies, etc. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. -> Dare County has a new CCHC! *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone (252) 333-1233; website - www.aacfnc.org . Reminders: Children’s Records – Children’s records were complete. Consider adding the wording for the Health Care Needs Section of the DCDEE Child’s Application for Enrollment verbatim to include the question, “Does your child have a Medical Action Plan?” Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. *We reviewed your staff worksheet. I highlighted items that were delinquent and items that are coming due in the next year. Health and Safety Training and Five (5) Year Cycle Tracking Requirements – Review Row 17 on Staff Worksheet for staff members needing initial H&S Training or five-year renewal. New staff are required to complete Health & Safety Training (H&S Training) within one year of hire (CPR/First Aid and Recognizing and Responding to Suspicions of Child Maltreatment within 3 months of hire) and then complete training in all topic areas every five years. *Free H&S Training available on Moodle and Prevent Child Abuse NC website. See Additional Comments for information on Moodle Support. On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours L. Rock will need by 2/14/24 (anniversary of last Annual Compliance visit) New staff will complete Health & Safety in their first year and then will complete on-going training annually based upon their level of education posted in DCDEE Works. *If staff have not met the required on-going training hours that are due by 2/14/24, I will review at the next visit. Staff need to complete the On-going Training Log and attach certificates. Activity Plans – Activity plans are essential to planning and preparing for children’s activities throughout the week and can make or break the flow of the classroom. Well-planned, intentional activities keep children engaged with less time for challenging behaviors. Date weekly activity plans and post where they are visible to parents. Include both free choice and teacher-directed activities, that allow children to choose to participate with the whole group, in a small group or independently. Listed activities must stimulate the following 5 developmental domains each day, as listed in the NC Foundations for Early Learning and Development book: social & emotional development (ESD), health & physical development (HPD), approaches to play and learning (APL), language development & communication (LDC), and cognitive development (CD). Plan for at least 4 activities daily, one of which must be a planned gross motor activity which may occur indoors or outdoors. The remaining 3 activities should occur in the following areas (art, books, blocks, manipulatives and dramatic play). In addition, plan for these 3 enrichment activities on at least a weekly basis: sand or water play; science and nature; and music and rhythm. Many teachers include these items daily also. To smoothly implement the daily activity plan, have materials and equipment available both inside and outside to support the activities listed. Nutrition – The two children’s files I reviewed did not include a Nutrition Opt-out form. The lunches observed met nutritional requirements but consider having all parents complete this form at enrollment so that you do not have to supplement meals if they are missing any food components. Diapering – Work with staff on the fine points of diapering. Need to remove gloves once the soiled diaper is removed and the bottom is wiped. Then use a wipe to clean adult hands and a wipe to clean child’s hands before putting on clean diaper. Contact S. Rosser, Child Care Health Consultant, to provide technical assistance with new staff. Additional Comments: Medicaid Expansion – Share with your staff! - Studies show that at least 25% of people working in child care in North Carolina do not have health insurance. Starting 12/1/2023, more North Carolinians can now get health coverage through Medicaid even if they haven’t qualified before. Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health services and more – at little or no cost to beneficiaries. Most people can get health care coverage through Medicaid if they meet the criteria below. • Live in North Carolina • Age 19 through 64 • Are a citizen. Some non-U.S. citizens can get health care coverage through Medicaid. • Have a household income that is below 138% of the federal poverty level. That’s about $20,000 for a single adult or about $34,000 for a family of three. If you were eligible for Medicaid prior to Dec 1, 2023, you still are. To learn more, go to Medicaid.nc.gov. Annual License Fee - There are a few changes to the Annual License Fee process this year: • All invoices will be emailed, and no paper copies will be sent through the U.S. Postal Service. • All invoices will be emailed by December 1, 2023 and will include the invoice number and total amount due. • All payments are due no later than December 31, 2023 Payments must be submitted online only through the Division’s website using a Mastercard or Visa debit or credit card, or by e-check. Providers will need their Facility ID number and their 2023 Invoice number to complete the payment process. If you have any questions, check the short Frequently Asked Questions on our website for answers or email DCDEE_LF@dhhs.nc.gov . I shared information on the following topics and emailed the information to you after the visit: 1. Free On-line Teacher Professional Development Memberships 2. How is it Going? We Want to Hear from You! 3. Unpacking ITERS-R: An Overview of the Infant/Toddler Environment Rating Scale 4. Clean Classrooms for Carolina Kids – required testing for lead in water, lead paint, asbestos 5. Resources from Health and Safety Resource Center! 6. Environmental Health Rules Update 7. Moodle Support Email and Phone Contact 8. NC Early Childhood Credential (NCECC) Equivalency Exam - Available on Moodle! 9. Challenging Behaviors Helpline! 10. Military Child Care in Your Neighborhood-Plus (MCCYN-PLUS) 11. NC Rated License Assessment Project (NCRLAP) Resources 12. NCID – Keep it active! Transition Back To Rated License Assessments And Cohorts To transition back to rated license assessments, the Division has created a two-year Cohort Model. All facilities are assigned to one of three cohorts based on their current rated license assessment due date. Each cohort will have a year for preparation and a year for assessment. (However, you are encouraged to begin preparations now so that you are ready when your cohort group is due!) Your child care center was due for a three-year rated license reassessment on 8/6/2021 and has been assigned to Cohort 1. The Cohort 1 Rated License Preparation Year is from 7/1/2023 – 6/30/2024. You are now halfway through your preparation year. During your preparation year, if you are interested in having the Environment Rating Scales completed, review the ITERS-R and ECERS-R by obtaining the manuals for each classroom and looking for assessment related resources at ncrlap.org. Request technical assistance and training for your staff from Children & Youth Partnership for Dare County. You can request and complete an ITERS-R and ECERS-R during your preparation year. If your scores help you meet or exceed your current star rating and you are ready to move forward with your rated license assessment, you may choose to do so during your preparation year. Your preparation year is also the time to continue to work on staff education and ensure that Works accounts are completed and up to date for staff members. Look at options to help staff earn the NC Early Childhood Credential (NCECC): completing EDU 119 at one of the NC Community Colleges, applying for Early Educator Certification through the NC Institute for Child Development Professionals, completing and passing the new NCECC Equivalency Exam option available on Moodle, or earning the Child Development Associate (CDA). Encourage staff with the NCECC to enroll in additional college coursework to increase points in Education. TEACH Scholarships are available to help staff pay for educational expenses. Go to https://www.childcareservices.org/programs/teach-north-carolina/ The Cohort 1 Rated License Assessment Year is from 7/1/2024 – 6/30/2025. During your assessment year you may choose to complete the ITERS-R and ECERS-R again at no cost even if you completed them during your preparation year. Use the feedback from your preparation year scores to create a plan to improve your scores. During this year, all education needs to be posted in Works. At some point during that year (based on the date of your Annual Compliance visit), you will have your rated license assessed. Update On Center’s Rated License Points: Program Standards – Currently Two (2) Points *will be reassessed if ITERS-R and ECERS-R are completed *meets enhanced space; will need to meet enhanced ratios to earn 3 points or higher Education Standards – Last Rated License - Four (4) Points – currently eligible for One (1) Point *Based in information available in DCDEE Works *Points are earned based on the lowest level of education for any one position. Administrator Education – 7 Points L. Jones-Hoats – NCECAC III w/ 36+y ec and ad exp = 7 points Lead Teacher Education – 7 Points: Currently eligible for 7 Points *SB 570 providing flexibility to allow 50% of lead teachers have AAS-ECE or higher at 7 Point level until 6/2023 Space 2 (Infants & 1’s) L. Rock – NCECC + 19 ECE w/ 18y exp = 5 points Space 3 (1’s & 2’s) B. Power Space 4 (not in use) Space 5 (2’s & 3’s) K. Pegues – sub Space 1 (3’s – 5’s) K. Petersen *Apply for Early Educator Certification to earn 7 points. (See below.) Early Educator Certification (EEC) is another option to earn education points for the rated license. To apply for Early Educator Certification, go to the website for the NC Institute for Child Development Professionals https://ncicdp.org/ 1. On the left, click on Certifications and Endorsements 2. Slide to the right to Early Educator Certification (EEC) Forms and Endorsements 3. Read the information and follow the instructions to apply. 4. Mail completed application, original, official transcripts (may be opened), and $50 application fee to NCICDP. 5. Once a certificate or letter verifying the award of the certificate is received, log into Works account and upload the EEC Certificate or Letter. EEC will expire, but it counts towards rated license points indefinitely if it is current when posted in Works. Quality Point - One (1) Point The center meets the following Education Options: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. Total the amount of points in Program Standards, Education Standards and Quality Point. 1 – 3 Points = One Star 4 – 6 Points = Two Stars 7 – 9 Points = Three Stars (required to accept subsidy) 10 – 12 Points = Four Stars 13 – 15 Points = Five Stars Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: Visit Date: 12/19/2023 Number Present: 14 Completed Date: 12/19/2023 Age: From 0 To 4 Total Minutes: 480 Time In: 09:00 AM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced * The purpose of today’s Annual Compliance visit was to monitor compliance with applicable child care requirements and continue discussions for the child care center’s rated license reassessment. Last Annual Compliance visit – 2/14/23 Last Sanitation Inspection – 12/13/23 with a Superior Rating; expires 12/13/24 Last Fire Inspection – 10/23/23 with Satisfactory rating; approved for daytime only *Sanitation and fire inspections are required at least annually by the date of the previous inspection. Send fire inspections to me within seven (7) days of the inspection. 18-month compliance history from 6/19/22 – 12/18/23 = 87% The facility currently operates with a Three-Star Center License, issued 11/18/2021 (restriction change), earning points in the following components: Program (2 PTS) + Education (4 PTS) + Quality Point (1 PT) = 7 Points = 3 Stars *Quality Point met and remains in effect: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. The next rated license assessment was due by 8/6/21. See below for more information about the Division’s plan to return to rated license assessments. This facility is owned by Healthy Environments Child Development Center Kdhnc LLC. According to the NC Secretary of State's website, this corporation is current and active as of 12/17/23. Please contact me prior to any information change regarding the ownership of this facility. License information was current. Contact me to make any changes to address, phone, or email or to request changes to the license. You have hired a new On-Site Assistant Administrator. She completed an Administrator Preservice Form and you signed it. I monitored the classrooms and spaces used for child care, kitchen, and outdoor play area for applicable child care center requirements using the Child Care Center Requirements, effective 7/1/2023 and Item Number Listing, effective 8/2023. I monitored two children’s records, nine staff records and all program records. The facility does not offer transportation. Center Observations: The facility was decorated for Christmas. Parent information was posted at the entrance along with the daily attendance sheet reflecting arrival and departure. Parents also check in and out on Brightwheel, and teachers document classroom arrival and departure times. All groups were participating in indoor free play with materials in defined activity centers. It was cold outdoors, but everyone older than the infants wrapped up and went outdoors where they had access to portable gross motor toys and make believe materials. When they returned indoors, they used the bathroom or were diapered and washed hands. Lunches were brought from home. Lunches observed met nutritional requirements. Children sat at child-sized tables, and teachers sat with them to provide close supervision and interactions. Later the older children slept on linen-covered cots. The one infant and one toddler present in Space 2 were cared for on their own schedule. Documentation of safe sleep checks was available and current. Feeding plans were posted, but one had not been updated to reflect the addition of table food to the infant’s feeding plan. Interactions were warm and nurturing. I spent time today reviewing children’s records and staff records with the new assistant administrator. I observed and documented the following violations during today’s visit. Violation Number Comment Rule 705 Equipment and furnishings were not sturdy, stable and free of hazards. Five rubber handlebar covers were missing from four tricycles on the playground creating a sharp edge and potential habitat from spiders and wasps. .0601(c) 808 The outdoor premises were not clean, drained and free of litter and hazardous materials grass and other vegetation in a manner which does not encourage vermin. Weeds with sharp thorns were growing along the fence, creating a habitat for pests and sharp thorns that could scratch or puncture children. 15A NCAC 18A .2832(a) 847 Parent's medication authorization did not include required information. Three medication permission forms for diaper creams were expired or did not include the required information. 10A NCAC 09 .0803(4)(6-9) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. Documentation of monthly outdoor inspections was not available for July 2023, September 2023, October 2023, and November 2023. .0605(q) 862 The EMC plan was not reviewed with all staff annually and whenever the plan was revised. The Emergency Medical Care Plan was not updated to reflect current staff and was not reviewed with staff in September 2023. 10A NCAC 09 .0802(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. A staff member was due for First Aid recertification by May 31, 2023 but did not complete First Aid until October 21, 2023. .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. A staff member was due for CPR recertification by May 31, 2023 but did not complete CPR until October 21, 2023. .1102(d) 1824 The trained staff did not review the EPR Plan annually or when information in the plan changed to ensure all information was current. The current EPR Plan was reviewed and updated in the Emergency Management Portal in February 2023, but the updated EPR Plan was not printed and reviewed with staff. .0607(e) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to S. Morris, authorized by L. Jones-Hoats to sign for today’s visit summary in her absence. We reviewed the visit summary and violation(s) documented during today’s visit. Correct these immediately. Send evidence of correction to me so that I receive it no later than 1/2/2024. The compliance verification letter needs to state the facility name and license number and list each violation by Item # and describe in detail when and how each violation has been corrected. If referring to staff or children in your compliance letter, refer to them by initials or position. Also include the following documents/pictures to verify compliance: copy of December Outdoor Inspection, updated copy of Emergency Medical Care Plan, updated copy of EPR Plan Send compliance verification letter in an email from the center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. If sent from another email address, the center’s official address must be Cc’d in the compliance email. You may include the compliance verification as an attachment or in the body of the email. If sufficient information is not received by the due date, a follow-up visit may be conducted. *I will email a sample compliance verification letter to you. *Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. Technical Assistance With Documented Violations: Playground Equipment – Ensuring that indoor and outdoor equipment is free from potential hazards provides a safe play space for children to freely use equipment to develop their gross motor skills. Several of the tricycles on the playground are missing rubber handles on the handle bars that protect the children from injury if they run into the handlebars and keep wasp or spiders from taking up residence in the hollow tubes of the handle bars. It is possible that you missed this because an outdoor inspection has not been completed since August 2023. Replace the rubber handle bar covers. Have all staff take Playground Safety Training so everyone can identify playground hazards and inform you when toys and equipment need maintenance or need to be removed. For your compliance letter, state that date when the handlebars on the tricycles have new rubber handlebar covers. Overgrowth and Debris on Playgrounds – Grass, weeds, and overgrowth along the inside and outside of fences must be maintained and cut back to prevent vermin and outdoor creatures from setting up residency or making themselves less visible. Vegetation that is potentially toxic or has sharp thorns also needs to be cut back. There are weeds growing along, over, and through the fence that have very sharp thorns and could scratch children. It is possible that you missed this because an outdoor inspection has not been completed since August 2023. Daily outdoor checks for trash, overgrowth, broken equipment, etc. are required daily. More extensive outdoor inspections are required to be completed and documented monthly. Cut back the weeds immediately. Consider clearing out two feet on the outside of the fence to better maintain vegetative growth at the fence. For your compliance letter, state the date the weeds along the fence line are removed. Medication Permission Forms - All medications for children present at the center must have a current, completed medication permission form even if there is a Medical Action Plan. The medication permission forms provide additional information that could be critical to the administration of the medication and the care of the child. The following medication forms in Space 5 (2’s and 3’s) did not include required information. 1. A&D Ointment for MV – authorized for 9/12/22 – 9/12/23 – authorization expired 2. Two forms for Boudreaux’s Butt Paste for HS – one authorized for 8/29/22 – 8/29/23 – authorization expired; the other was incomplete and did not include a 12-month authorization period, amount of diaper cream to be administered and when to administer diaper cream. Also include full name of child on form. Also label medications with children’s names or at least initials. Keep a sharpie handy. Because of the administrator turnover, medication boxes have not been monitored. Medication permission forms for OTC, prescription, and emergency medication have an administration log as part of the form. This must be completed any time the medication is given. Update the medication permission forms or return the medication to families. Also review all medication and medication permission forms to ensure they are current and complete. For your compliance letter, state the date all medication and medication permission forms are up-to-date or returned to families. Outdoor Inspections and Playground Safety Training - Regular outdoor inspections are critical to prevent deterioration of equipment and accumulation of hazardous materials within the play site, and to ensure that appropriate repairs are made as soon as possible. A monthly safety check of all the equipment within the facility as a focused task provides an opportunity to notice wear and tear that requires maintenance. Documentation of monthly outdoor inspections was not available for July 2023, September 2023, October 2023, and November 2023. You stated due to the change in on-site administration since the spring, outdoor inspections have been overlooked. Monthly inspections of the outdoor play area are required to be completed by a designated staff member with Playground Safety Training. L. Jones-Hoats and L. Rock are the only center staff with Playground Safety Training, so they need to complete monthly outdoor inspections. The new assistant administrator should consider completing Playground Safety Training so that she can assist with those responsibilities. For your compliance letter, complete and document an Outdoor Inspection for December and describe how you will ensure they are completed monthly. In addition to your compliance letter, scan and include a copy of the December outdoor inspection. Emergency Medical Care Plan (EMCP) – Updating the Emergency Medical Care Plan when there are staff changes and reviewing it with staff as changes occur or at least annually ensures that all staff know their role in a staff or medical emergency. The posted EMCP has a previous administrator listed and has not been updated. In addition, the EMCP was not reviewed with staff in September 2023. Update and post the Emergency Medical Care Plan. Review with staff when they return in January 2024. For your compliance letter, state the date the EMCP is updated and the date it is reviewed with staff. Also send a copy of the updated Emergency Medical Care Plan. First Aid and CPR – Early care and education programs with staff trained in pediatric first aid and CPR can mitigate the consequences of injury and reduce the potential for death from life-threatening conditions and emergencies. Repetitive training, coupled with the confidence to use these skills, are critically important to the outcome of an emergency. (Caring for Our Children, 4th Edition). K. Pegues was due to recertify First Aid and CPR by 5/31/2023 but did not complete the training until 10/21/2023. You stated that the administrator who worked during the spring and summer of 2023 overlooked the need for CPR/First Aid training. By reviewing and updating staff worksheets at least monthly, you can track expiration dates for trainings, criminal background checks and annual forms. This has been corrected. No further action or documentation in required except to maintain current First Aid and CPR in the future. Repeated CPR/First Aid violations may result in an Administrative Action. *New staff need to complete First Aid and CPR within three months of hire. See Row 19 on your staff worksheet to see who needs First Aid and CPR training. Consider having a class for all of them before the first one is due on 2/29/2024. Emergency Preparedness and Response (EPR) Requirements – Reviewing and updating your EPR Plan ensures that emergency procedures are current based on your enrollment, staff, and new recommendations for lock downs, shelter-in-place, or evacuations. You last updated your EPR Plan in February 2023 but did not print out an updated copy or at least a new cover sheet and Page 28 reflecting the date of your review and updates. *Log into the Emergency Management Portal on the DCDEE website -> Provider tab -> Emergency Preparedness and Response -> Emergency Management Portal -> Log in using NCID used to create or update EPR Plan. Review the EPR Plan and update as needed. Document review date on page 28. If changes are needed, print plan up to page 29. If no changes are needed, print pages 1 and 28 with review date reflected. Review updated EPR Plan with staff and during orientation with new staff. Use this time to also review and update Emergency Medical Care Plan and review with staff also. * If you have questions, or need assistance with accessing your EPR Plan contact Amia M. Eaton, Training and Program Development Consultant Amia.Eaton@dhhs.nc.gov *For your compliance letter, state the date your EPR Plan is updated and attach a copy of the plan in the email with your compliance letter. General Visit Information: Be knowledgeable of the child care laws and rules and environmental health rules; review them with your staff and assist them with understanding and implementing them to maintain compliance and keep children safe and healthy. The most recent versions of child care laws and rules (updated 7/1/23) and environmental health rules (updated 7/1/23) in North Carolina, the Items Number Listing (can be used as a detailed checklist of required items) and What’s New information are available on the DCDEE website, www.ncchildcare.ncdhhs.gov. Check the designated facility email at least weekly to stay current with communication and email blasts from DCDEE. If your email is not the facility email, sign up for email blasts on the What’s New page for general information and communication from DCDEE. Your local and regional Smart Start Partnerships and Child Care Resource and Referral Agencies are available to assist you with technical assistance and training on a multitude of topics including but not limited to: Environment Rating Scales, infant/toddler practices, healthy behaviors and classroom management, developmentally appropriate practice, EPR plans, activity plans, NC Foundations for Early Learning (developmental domains), etc. Child Care Health Consultants can provide training and technical assistance on topics related to health and safety such as sanitation, handwashing, diapering, illness policies, etc. *Children & Youth Partnership for Dare County: Phone - (252) 441-0614; website - www.darekids.org. -> Dare County has a new CCHC! *Child Care Health Consultant – S. Rosser - Office: (252) 557-4208 or stacy_rosser@unc.edu *Albemarle Alliance for Children and Families (AACF) and Region 1 Child Care Resource and Referral: Phone (252) 333-1233; website - www.aacfnc.org . Reminders: Children’s Records – Children’s records were complete. Consider adding the wording for the Health Care Needs Section of the DCDEE Child’s Application for Enrollment verbatim to include the question, “Does your child have a Medical Action Plan?” Staff Worksheets – Your Staff Worksheets are a great tool to help you track when items such as Criminal Background Checks, required trainings and staff forms expire and need to be updated. I encourage you to update information on the staff worksheets throughout the year as items are updated and/or staff change. *We reviewed your staff worksheet. I highlighted items that were delinquent and items that are coming due in the next year. Health and Safety Training and Five (5) Year Cycle Tracking Requirements – Review Row 17 on Staff Worksheet for staff members needing initial H&S Training or five-year renewal. New staff are required to complete Health & Safety Training (H&S Training) within one year of hire (CPR/First Aid and Recognizing and Responding to Suspicions of Child Maltreatment within 3 months of hire) and then complete training in all topic areas every five years. *Free H&S Training available on Moodle and Prevent Child Abuse NC website. See Additional Comments for information on Moodle Support. On-going Training Hours – Review Row 18 (# hours to carry over) on the Staff Worksheets to determine how many on-going training hours L. Rock will need by 2/14/24 (anniversary of last Annual Compliance visit) New staff will complete Health & Safety in their first year and then will complete on-going training annually based upon their level of education posted in DCDEE Works. *If staff have not met the required on-going training hours that are due by 2/14/24, I will review at the next visit. Staff need to complete the On-going Training Log and attach certificates. Activity Plans – Activity plans are essential to planning and preparing for children’s activities throughout the week and can make or break the flow of the classroom. Well-planned, intentional activities keep children engaged with less time for challenging behaviors. Date weekly activity plans and post where they are visible to parents. Include both free choice and teacher-directed activities, that allow children to choose to participate with the whole group, in a small group or independently. Listed activities must stimulate the following 5 developmental domains each day, as listed in the NC Foundations for Early Learning and Development book: social & emotional development (ESD), health & physical development (HPD), approaches to play and learning (APL), language development & communication (LDC), and cognitive development (CD). Plan for at least 4 activities daily, one of which must be a planned gross motor activity which may occur indoors or outdoors. The remaining 3 activities should occur in the following areas (art, books, blocks, manipulatives and dramatic play). In addition, plan for these 3 enrichment activities on at least a weekly basis: sand or water play; science and nature; and music and rhythm. Many teachers include these items daily also. To smoothly implement the daily activity plan, have materials and equipment available both inside and outside to support the activities listed. Nutrition – The two children’s files I reviewed did not include a Nutrition Opt-out form. The lunches observed met nutritional requirements but consider having all parents complete this form at enrollment so that you do not have to supplement meals if they are missing any food components. Diapering – Work with staff on the fine points of diapering. Need to remove gloves once the soiled diaper is removed and the bottom is wiped. Then use a wipe to clean adult hands and a wipe to clean child’s hands before putting on clean diaper. Contact S. Rosser, Child Care Health Consultant, to provide technical assistance with new staff. Additional Comments: Medicaid Expansion – Share with your staff! - Studies show that at least 25% of people working in child care in North Carolina do not have health insurance. Starting 12/1/2023, more North Carolinians can now get health coverage through Medicaid even if they haven’t qualified before. Medicaid pays for doctor visits, yearly check-ups, emergency care, mental health services and more – at little or no cost to beneficiaries. Most people can get health care coverage through Medicaid if they meet the criteria below. • Live in North Carolina • Age 19 through 64 • Are a citizen. Some non-U.S. citizens can get health care coverage through Medicaid. • Have a household income that is below 138% of the federal poverty level. That’s about $20,000 for a single adult or about $34,000 for a family of three. If you were eligible for Medicaid prior to Dec 1, 2023, you still are. To learn more, go to Medicaid.nc.gov. Annual License Fee - There are a few changes to the Annual License Fee process this year: • All invoices will be emailed, and no paper copies will be sent through the U.S. Postal Service. • All invoices will be emailed by December 1, 2023 and will include the invoice number and total amount due. • All payments are due no later than December 31, 2023 Payments must be submitted online only through the Division’s website using a Mastercard or Visa debit or credit card, or by e-check. Providers will need their Facility ID number and their 2023 Invoice number to complete the payment process. If you have any questions, check the short Frequently Asked Questions on our website for answers or email DCDEE_LF@dhhs.nc.gov . I shared information on the following topics and emailed the information to you after the visit: 1. Free On-line Teacher Professional Development Memberships 2. How is it Going? We Want to Hear from You! 3. Unpacking ITERS-R: An Overview of the Infant/Toddler Environment Rating Scale 4. Clean Classrooms for Carolina Kids – required testing for lead in water, lead paint, asbestos 5. Resources from Health and Safety Resource Center! 6. Environmental Health Rules Update 7. Moodle Support Email and Phone Contact 8. NC Early Childhood Credential (NCECC) Equivalency Exam - Available on Moodle! 9. Challenging Behaviors Helpline! 10. Military Child Care in Your Neighborhood-Plus (MCCYN-PLUS) 11. NC Rated License Assessment Project (NCRLAP) Resources 12. NCID – Keep it active! Transition Back To Rated License Assessments And Cohorts To transition back to rated license assessments, the Division has created a two-year Cohort Model. All facilities are assigned to one of three cohorts based on their current rated license assessment due date. Each cohort will have a year for preparation and a year for assessment. (However, you are encouraged to begin preparations now so that you are ready when your cohort group is due!) Your child care center was due for a three-year rated license reassessment on 8/6/2021 and has been assigned to Cohort 1. The Cohort 1 Rated License Preparation Year is from 7/1/2023 – 6/30/2024. You are now halfway through your preparation year. During your preparation year, if you are interested in having the Environment Rating Scales completed, review the ITERS-R and ECERS-R by obtaining the manuals for each classroom and looking for assessment related resources at ncrlap.org. Request technical assistance and training for your staff from Children & Youth Partnership for Dare County. You can request and complete an ITERS-R and ECERS-R during your preparation year. If your scores help you meet or exceed your current star rating and you are ready to move forward with your rated license assessment, you may choose to do so during your preparation year. Your preparation year is also the time to continue to work on staff education and ensure that Works accounts are completed and up to date for staff members. Look at options to help staff earn the NC Early Childhood Credential (NCECC): completing EDU 119 at one of the NC Community Colleges, applying for Early Educator Certification through the NC Institute for Child Development Professionals, completing and passing the new NCECC Equivalency Exam option available on Moodle, or earning the Child Development Associate (CDA). Encourage staff with the NCECC to enroll in additional college coursework to increase points in Education. TEACH Scholarships are available to help staff pay for educational expenses. Go to https://www.childcareservices.org/programs/teach-north-carolina/ The Cohort 1 Rated License Assessment Year is from 7/1/2024 – 6/30/2025. During your assessment year you may choose to complete the ITERS-R and ECERS-R again at no cost even if you completed them during your preparation year. Use the feedback from your preparation year scores to create a plan to improve your scores. During this year, all education needs to be posted in Works. At some point during that year (based on the date of your Annual Compliance visit), you will have your rated license assessed. Update On Center’s Rated License Points: Program Standards – Currently Two (2) Points *will be reassessed if ITERS-R and ECERS-R are completed *meets enhanced space; will need to meet enhanced ratios to earn 3 points or higher Education Standards – Last Rated License - Four (4) Points – currently eligible for One (1) Point *Based in information available in DCDEE Works *Points are earned based on the lowest level of education for any one position. Administrator Education – 7 Points L. Jones-Hoats – NCECAC III w/ 36+y ec and ad exp = 7 points Lead Teacher Education – 7 Points: Currently eligible for 7 Points *SB 570 providing flexibility to allow 50% of lead teachers have AAS-ECE or higher at 7 Point level until 6/2023 Space 2 (Infants & 1’s) L. Rock – NCECC + 19 ECE w/ 18y exp = 5 points Space 3 (1’s & 2’s) B. Power Space 4 (not in use) Space 5 (2’s & 3’s) K. Pegues – sub Space 1 (3’s – 5’s) K. Petersen *Apply for Early Educator Certification to earn 7 points. (See below.) Early Educator Certification (EEC) is another option to earn education points for the rated license. To apply for Early Educator Certification, go to the website for the NC Institute for Child Development Professionals https://ncicdp.org/ 1. On the left, click on Certifications and Endorsements 2. Slide to the right to Early Educator Certification (EEC) Forms and Endorsements 3. Read the information and follow the instructions to apply. 4. Mail completed application, original, official transcripts (may be opened), and $50 application fee to NCICDP. 5. Once a certificate or letter verifying the award of the certificate is received, log into Works account and upload the EEC Certificate or Letter. EEC will expire, but it counts towards rated license points indefinitely if it is current when posted in Works. Quality Point - One (1) Point The center meets the following Education Options: The child care administrator has 10 years of documented administrative work experience in a licensed child care center that can be verified by the Division. Total the amount of points in Program Standards, Education Standards and Quality Point. 1 – 3 Points = One Star 4 – 6 Points = Two Stars 7 – 9 Points = Three Stars (required to accept subsidy) 10 – 12 Points = Four Stars 13 – 15 Points = Five Stars Thank you for your time and assistance today. Refer to this visit summary for a refresher of our discussions today, and I encourage you to share with staff and use the information as a teaching tool. If you have any questions, do not hesitate to call or email me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0823-142L Visit Date: 8/14/2023 Number Present: 23 Completed Date: 8/14/2023 Age: From 0 To 4 Total Minutes: 165 Time In: 02:00 PM Time Out: 04:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: 1. There are concerns that children care were cared for in an unsafe environment. 2. There are concerns that children were not adequately supervised. I completed limited monitoring of child care requirements during the visit. Supervision of children, staff/child ratios, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. I also reviewed staff qualification letters for new staff. The following staff/child ratios (S/C) were observed in Space 1 Space 1 – 9 children, ages 3 – 5 years (L. Hamilton, C. Poe) S/C ratios = 1:9 INVESTIGATION The allegations were shared with the administrator and one staff member. Allegation #1: There are concerns that children care were cared for in an unsafe environment. . Your Responses: The administrator stated that she was on vacation the week that the reported incident occurred. She also stated that the staff member involved in the incident had her last day on Friday, 8/11/2023 and has left for college. A second staff member who was present the day of the reported incident stated that the fenced playground behind the center was closed the afternoon of Tuesday, 8/8/2023 because a teacher has been stung by a venomous caterpillar in the morning, and the owner did not want anyone on the playground until the pest control company could spray. She said that in the afternoon around pick-up time, three boys, all three years of age, in Space 1, were being rambunctious in the classroom and the summer floater offered to take them on the front porch to run up and down the ramp to get their wiggles out. She said that the floater positioned herself at the turn in the ramp and the boys ran down to her and back up the ramp. At the same time a parent arrived through the gate at the top of the steps and did not fully latch the gate. One of boys saw the open gate, ran through it and down the stairs into the parking lot. The other two boys followed. They went around the west side of center leading to the playground gate. The floater immediately ran after them and was able to bring them back to the front door and into the center. The staff member said that she shared the incident with each of the parents when they arrived to pick up the children, and the owner spoke with each of the parents over the phone. My Observations: There is a gate that latches at the top of the steps to the front porch and front door. There is no gate at the top or bottom of the ramp. Based upon your statements and my observations, this allegation is confirmed. Allegation #2: There are concerns that children were not adequately supervised. Your Responses: See above responses. My Observations: Staff in all classrooms provided adequate supervision during today’s observations and could see and hear children at all times. Based upon your statements, this allegation is confirmed. The following items were documented as violations during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Three children, three years of age, playing on the front porch with a teacher, ran into the parking lot and around the side of the center through an unlatched gate. .1801(a)(1-5) 826 Gates to the fenced outdoor play area did not remain closed while children occupied the area. The gate leading from the front porch to the parking lot was not completely latched, and three children, three years of age, playing on the porch and ramp ran through the unlatched gate into the parking lot. .0605(i) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to you, A. Leary, Administrator. We reviewed the visit summary and violation(s) documented during today’s visit. Correct these immediately. Send evidence of correction to me so that I receive it no later than 8/28/2023. Your compliance verification letter needs to include the following: 1. Name of facility and facility license # 2. Name of person writing compliance letter and position 3. Date of monitoring visit when violations were documented 4. Date compliance letter written 5. List each violation by Item # and describe when and how each violation has been corrected. 6. Send compliance verification letter in an email from your center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. If sent from another email address, the center’s official address must be Cc’d in the compliance email. 7. You may include the compliance verification as an attachment or in the body of the email. 8. If sufficient information is not received by the due date, a follow-up visit may be conducted. *I will email a sample compliance verification letter to you. *Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. Violations were documented that require a follow-up visit. An unannounced visit will be made soon to verify correction of violations. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. TECHNICAL ASSISTANCE WITH DOCUMENTED VIOLATIONS – Supervision – Supervision is directly tied to safety and the prevention of injury and maintaining quality child care for infants, toddlers, and preschoolers. Parents/guardians depend on caregivers/teachers to supervise their children. Responsive interactions and understanding each child’s strengths and challenges while providing active supervision for young children helps them learn to challenge themselves in a safe environment. To review the rules on Supervision in Child Care Centers, see 10A NCAC 09 .1801. The owner who self-reported the incident, stated that looking back at the situation, using the ramp for outdoor play during pick-up time was not a wise decision because of parents coming in and out the gate with the potential for leaving it partially open and causing supervision issues. She stated that outdoor play on the front porch will be discontinued until a gate can be installed at the bottom of the ramp and she can ensure that the latch on the gate at the top of the steps can be easily closed when parents are coming in and out. Outdoor play on the porch will also not occur during drop-off or pick-up times. Gate – Outdoor play spaces need to be fenced to prevent children from leaving the supervised play space and running into a potentially dangerous situation and to keep potentially dangerous animals and people out of the fenced space. Gates used to access the fenced play area or front porch must be securely closed while children are playing in the space. CONSULTATION: When weather or other temporary conditions do not permit outside play, have indoor gross motor materials available such as bean bag toss, crawling tunnels, materials to set up an indoor obstacle course etc. or provide some movement activities to offer children indoor active play. REMINDERS: Annual Licensing Fee – Licensed facilities that have a current license (whether active or inactive) on October 1st of each year will receive an invoice for a licensing fee based on their licensed capacity. Invoices will be mailed out in November and must be paid on-line. For more information, watch for the Email Blasts from NC DHHS to your facility email address. If you plan to make any changes to your license, notify me by 9/15/2023 so the process can take place prior to October 1st. ADDITIONAL COMMENTS: New Challenging Behaviors Helpline! – A new helpline is available for teachers and staff to call or email for advice and resources to assist with challenging behaviors in your classrooms! I shared the Helpline poster with you and encourage you to share with staff in each classroom. COMPLIANCE HISTORY: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 2/12/2022 – 8/11/2023 is 89%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to sections labeled Technical Assistance, Consultation, Reminders, and Additional Comments for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report 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: HEALTHY ENVIRONMENTS CHILD DEVELOPMENT CENTER KDH Facility ID: 28000267 Consultant: MARJORIE WHITE Operation Type: Center Case Number: 0823-142L Visit Date: 8/14/2023 Number Present: 23 Completed Date: 8/14/2023 Age: From 0 To 4 Total Minutes: 165 Time In: 02:00 PM Time Out: 04:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced * The purpose of today's unannounced visit was to obtain information regarding alleged violations of child care requirements. The allegations are as follows: 1. There are concerns that children care were cared for in an unsafe environment. 2. There are concerns that children were not adequately supervised. I completed limited monitoring of child care requirements during the visit. Supervision of children, staff/child ratios, adequate/approved space and permit restrictions were observed in compliance at the time of my observations. I also reviewed staff qualification letters for new staff. The following staff/child ratios (S/C) were observed in Space 1 Space 1 – 9 children, ages 3 – 5 years (L. Hamilton, C. Poe) S/C ratios = 1:9 INVESTIGATION The allegations were shared with the administrator and one staff member. Allegation #1: There are concerns that children care were cared for in an unsafe environment. . Your Responses: The administrator stated that she was on vacation the week that the reported incident occurred. She also stated that the staff member involved in the incident had her last day on Friday, 8/11/2023 and has left for college. A second staff member who was present the day of the reported incident stated that the fenced playground behind the center was closed the afternoon of Tuesday, 8/8/2023 because a teacher has been stung by a venomous caterpillar in the morning, and the owner did not want anyone on the playground until the pest control company could spray. She said that in the afternoon around pick-up time, three boys, all three years of age, in Space 1, were being rambunctious in the classroom and the summer floater offered to take them on the front porch to run up and down the ramp to get their wiggles out. She said that the floater positioned herself at the turn in the ramp and the boys ran down to her and back up the ramp. At the same time a parent arrived through the gate at the top of the steps and did not fully latch the gate. One of boys saw the open gate, ran through it and down the stairs into the parking lot. The other two boys followed. They went around the west side of center leading to the playground gate. The floater immediately ran after them and was able to bring them back to the front door and into the center. The staff member said that she shared the incident with each of the parents when they arrived to pick up the children, and the owner spoke with each of the parents over the phone. My Observations: There is a gate that latches at the top of the steps to the front porch and front door. There is no gate at the top or bottom of the ramp. Based upon your statements and my observations, this allegation is confirmed. Allegation #2: There are concerns that children were not adequately supervised. Your Responses: See above responses. My Observations: Staff in all classrooms provided adequate supervision during today’s observations and could see and hear children at all times. Based upon your statements, this allegation is confirmed. The following items were documented as violations during today’s visit: Violation Number Comment Rule 303 Children were not adequately supervised at all times. Three children, three years of age, playing on the front porch with a teacher, ran into the parking lot and around the side of the center through an unlatched gate. .1801(a)(1-5) 826 Gates to the fenced outdoor play area did not remain closed while children occupied the area. The gate leading from the front porch to the parking lot was not completely latched, and three children, three years of age, playing on the porch and ramp ran through the unlatched gate into the parking lot. .0605(i) * Child care programs are expected to achieve and always maintain compliance and are required by NC GS 110-90(4)(d) to achieve and maintain an 18-month compliance history score of at least 75%. Any violations documented may impact the compliance history score. I completed an electronic copy of the visit summary and provided a printed copy of it to you, A. Leary, Administrator. We reviewed the visit summary and violation(s) documented during today’s visit. Correct these immediately. Send evidence of correction to me so that I receive it no later than 8/28/2023. Your compliance verification letter needs to include the following: 1. Name of facility and facility license # 2. Name of person writing compliance letter and position 3. Date of monitoring visit when violations were documented 4. Date compliance letter written 5. List each violation by Item # and describe when and how each violation has been corrected. 6. Send compliance verification letter in an email from your center’s official email address, hecdckdhnc@gmail.com to my email address, Marjorie.White@dhhs.nc.gov. If sent from another email address, the center’s official address must be Cc’d in the compliance email. 7. You may include the compliance verification as an attachment or in the body of the email. 8. If sufficient information is not received by the due date, a follow-up visit may be conducted. *I will email a sample compliance verification letter to you. *Please be aware that any information submitted by you is legal documentation. If it is determined the information provided in the compliance letter is not true, this may be considered falsification of information. Violations were documented that require a follow-up visit. An unannounced visit will be made soon to verify correction of violations. If I may be of further assistance, please contact me by phone at (252) 373-9385, by e-mail at Marjorie.White@dhhs.nc.gov. You may also call Jennifer Linhardt, Licensing Supervisor, at (252) 373-4199 or Jennifer.Linhardt@dhhs.nc.gov. TECHNICAL ASSISTANCE WITH DOCUMENTED VIOLATIONS – Supervision – Supervision is directly tied to safety and the prevention of injury and maintaining quality child care for infants, toddlers, and preschoolers. Parents/guardians depend on caregivers/teachers to supervise their children. Responsive interactions and understanding each child’s strengths and challenges while providing active supervision for young children helps them learn to challenge themselves in a safe environment. To review the rules on Supervision in Child Care Centers, see 10A NCAC 09 .1801. The owner who self-reported the incident, stated that looking back at the situation, using the ramp for outdoor play during pick-up time was not a wise decision because of parents coming in and out the gate with the potential for leaving it partially open and causing supervision issues. She stated that outdoor play on the front porch will be discontinued until a gate can be installed at the bottom of the ramp and she can ensure that the latch on the gate at the top of the steps can be easily closed when parents are coming in and out. Outdoor play on the porch will also not occur during drop-off or pick-up times. Gate – Outdoor play spaces need to be fenced to prevent children from leaving the supervised play space and running into a potentially dangerous situation and to keep potentially dangerous animals and people out of the fenced space. Gates used to access the fenced play area or front porch must be securely closed while children are playing in the space. CONSULTATION: When weather or other temporary conditions do not permit outside play, have indoor gross motor materials available such as bean bag toss, crawling tunnels, materials to set up an indoor obstacle course etc. or provide some movement activities to offer children indoor active play. REMINDERS: Annual Licensing Fee – Licensed facilities that have a current license (whether active or inactive) on October 1st of each year will receive an invoice for a licensing fee based on their licensed capacity. Invoices will be mailed out in November and must be paid on-line. For more information, watch for the Email Blasts from NC DHHS to your facility email address. If you plan to make any changes to your license, notify me by 9/15/2023 so the process can take place prior to October 1st. ADDITIONAL COMMENTS: New Challenging Behaviors Helpline! – A new helpline is available for teachers and staff to call or email for advice and resources to assist with challenging behaviors in your classrooms! I shared the Helpline poster with you and encourage you to share with staff in each classroom. COMPLIANCE HISTORY: I reviewed the facility’s compliance history with the administrator. The 18-month compliance history from 2/12/2022 – 8/11/2023 is 89%. Please be aware that any information received during this investigation and any violations documented may be included in any future administrative actions. Violations of child care requirements, particularly repeated violations, could result in a civil penalty and/or administrative action that could jeopardize the status of the license for the child care facility. Please also refer to sections labeled Technical Assistance, Consultation, Reminders, and Additional Comments for a refresher of our discussions today. If you have any questions, do not hesitate to contact me at the contact information listed above. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times