Learning Tree Childcare Center

10A NCAC 09 .0304 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: MELINDA LESCAR Operation Type: Center Case Number: Visit Date: 6/29/2026 Number Present: 41 Completed Date: 6/29/2026 Age: From 0 To 12 Total Minutes: 215 Time In: 09:40 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for an annual compliance visit. This visit was conducted with Makayla Edwards, Administrator and Cheyenne Lopez, Operations Manager. Your program currently operates with a Three-Star License. Your program Restrictions include 1st shift care; meets enhanced space and enhanced ratios; children under 2 ½ years old in rooms with direct exits only. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 6/26/2026 and Learning Tree Childcare Center, LLC was listed as current and active. The program’s compliance history was 97% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children in outdoor play and free play activities. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 7/2/2025. A sanitation inspection was completed 6/26/2026 with an Approved classification. The last fire inspection was conducted on 3/10/2025. The administrator has made several calls to have your fire extinguishers inspected so that the fire inspection can be conducted. Program records and required postings were monitored. A fire drill was conducted on 5/29/2026. A lock down drill was documented on 3/23/2026. An outdoor inspection was documented on 5/22/2026. Staff files and children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Hazardous items were stored in locked laundry room and cabinet in the kitchen. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on March 10. 2025. 10A NCAC 09 .0304(a) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. Two current staff members were not linked to the facility's roster. G.S. 110-90.2 & .2703(r) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before July 13, 2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to: melinda.lescar@dhhs.nc.gov or mail two copies of the letter to: Melinda Lescar P.O. Box 25174 Winston-Salem, NC 27114 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit related to violations: Item #1805- Two (2) current employees were not linked to the facility’s roster. It is important to link all new employees within 5 business days of being hired. This was corrected during the visit. You must notify your consultant 30 days prior to changing the ownership status of your facility. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Melinda Lescar, Child Care Consultant, (336) 987-0960, melinda.lescar@dhhs.nc.gov or Pam Hauser, Supervisor, (336) 317-5003, pamela.hauser@dhhs.nc.gov if you have questions. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: MELINDA LESCAR Operation Type: Center Case Number: Visit Date: 6/29/2026 Number Present: 41 Completed Date: 6/29/2026 Age: From 0 To 12 Total Minutes: 215 Time In: 09:40 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for an annual compliance visit. This visit was conducted with Makayla Edwards, Administrator and Cheyenne Lopez, Operations Manager. Your program currently operates with a Three-Star License. Your program Restrictions include 1st shift care; meets enhanced space and enhanced ratios; children under 2 ½ years old in rooms with direct exits only. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 6/26/2026 and Learning Tree Childcare Center, LLC was listed as current and active. The program’s compliance history was 97% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children in outdoor play and free play activities. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 7/2/2025. A sanitation inspection was completed 6/26/2026 with an Approved classification. The last fire inspection was conducted on 3/10/2025. The administrator has made several calls to have your fire extinguishers inspected so that the fire inspection can be conducted. Program records and required postings were monitored. A fire drill was conducted on 5/29/2026. A lock down drill was documented on 3/23/2026. An outdoor inspection was documented on 5/22/2026. Staff files and children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Hazardous items were stored in locked laundry room and cabinet in the kitchen. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on March 10. 2025. 10A NCAC 09 .0304(a) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. Two current staff members were not linked to the facility's roster. G.S. 110-90.2 & .2703(r) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before July 13, 2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to: melinda.lescar@dhhs.nc.gov or mail two copies of the letter to: Melinda Lescar P.O. Box 25174 Winston-Salem, NC 27114 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit related to violations: Item #1805- Two (2) current employees were not linked to the facility’s roster. It is important to link all new employees within 5 business days of being hired. This was corrected during the visit. You must notify your consultant 30 days prior to changing the ownership status of your facility. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Melinda Lescar, Child Care Consultant, (336) 987-0960, melinda.lescar@dhhs.nc.gov or Pam Hauser, Supervisor, (336) 317-5003, pamela.hauser@dhhs.nc.gov if you have questions. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: MELINDA LESCAR Operation Type: Center Case Number: Visit Date: 6/29/2026 Number Present: 41 Completed Date: 6/29/2026 Age: From 0 To 12 Total Minutes: 215 Time In: 09:40 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for an annual compliance visit. This visit was conducted with Makayla Edwards, Administrator and Cheyenne Lopez, Operations Manager. Your program currently operates with a Three-Star License. Your program Restrictions include 1st shift care; meets enhanced space and enhanced ratios; children under 2 ½ years old in rooms with direct exits only. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 6/26/2026 and Learning Tree Childcare Center, LLC was listed as current and active. The program’s compliance history was 97% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children in outdoor play and free play activities. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 7/2/2025. A sanitation inspection was completed 6/26/2026 with an Approved classification. The last fire inspection was conducted on 3/10/2025. The administrator has made several calls to have your fire extinguishers inspected so that the fire inspection can be conducted. Program records and required postings were monitored. A fire drill was conducted on 5/29/2026. A lock down drill was documented on 3/23/2026. An outdoor inspection was documented on 5/22/2026. Staff files and children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Hazardous items were stored in locked laundry room and cabinet in the kitchen. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 106 Operator has not scheduled and obtained a fire inspection within 12 months of the previous inspection. Operator did not submit the original approved report to DCDEE within one week of the inspection visit on a form provided by the Division. The last fire inspection was conducted on March 10. 2025. 10A NCAC 09 .0304(a) 1805 A child care operator did not notify the Division of any new child care providers, as defined in G.S. 110-90.2(a)(2), who were hired or moved into the child care facility within five business days. Two current staff members were not linked to the facility's roster. G.S. 110-90.2 & .2703(r) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before July 13, 2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to: melinda.lescar@dhhs.nc.gov or mail two copies of the letter to: Melinda Lescar P.O. Box 25174 Winston-Salem, NC 27114 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit related to violations: Item #1805- Two (2) current employees were not linked to the facility’s roster. It is important to link all new employees within 5 business days of being hired. This was corrected during the visit. You must notify your consultant 30 days prior to changing the ownership status of your facility. At the completion of the visit, this visit summary was printed, reviewed, and a copy was left with you. Contact me at Melinda Lescar, Child Care Consultant, (336) 987-0960, melinda.lescar@dhhs.nc.gov or Pam Hauser, Supervisor, (336) 317-5003, pamela.hauser@dhhs.nc.gov if you have questions. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/2/2025 Number Present: 34 Completed Date: 7/2/2025 Age: From 0 To 11 Total Minutes: 210 Time In: 09:45 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted with Makayla Edwards, the Administrator. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 06/25/25 and Learning Tree Childcare Center, LLC was listed as current and active. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children having outdoor gross motor play, preparing for and having lunch. Infants were having their individual needs met. I observed materials and activities that were available to the children in the classrooms. Your facility uses the Brightwheel “Experience” curriculum. The last annual compliance visit was conducted on 7/9/24. A sanitation inspection was completed 6/18/25 with a Superior classification and thirteen (13) demerits. The last fire inspection was conducted on 3/10/25. A copy was received today on the visit. Program records and required postings were monitored. A fire drill was conducted on 6/18/25 at 9:59 am with two (2) minutes three (3) seconds to evacuate thirty-seven (37) children and eight (8) adults by M. Edwards. A shelter in place drill was documented on 6/20/25 at 3:15 pm with fifty-eight (58) seconds to shelter-in-place by M. Edwards. An outdoor inspection was documented on 7/1/25 by M. Edwards. Two (2) new staff files and one (1) other staff file and four (4) children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Hazardous items were stored in locked closets. Storage and administration of medication were monitored. Medication authorization was monitored. One (1) ADHD medication was monitored with required paperwork today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 807 A safe indoor and outdoor environment was not provided for the children. The door to the playground from the inside hallway of the building has a wooden frame that is broken at the bottom left of the outside door. This door frame will need repair. The back gate to the back side of the building must have a carabiner lock to prevent children from going outside since the latch is low and accessible to children. The two (2) red musical instruments on the playgrounds have the footings exposed which is a tripping/fall hazard to children and or staff. Ground cover was exposed through the blue mulch causing a tripping hazard. 10A NCAC 09 .0601(a) You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Wednesday, July 16, 2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to: karen.young@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action being taken by the DCDEE. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit related to violations: • A safe indoor and outdoor environment is required where children are in care to prevent tripping, falling, or getting out of a fenced area. Refer to Childcare Rule 10A NCAC .09 .? Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The QRIS is being implemented, and I will keep you updated as more information is shared with consultants. • ITERS-3 & ECERS-3 are now being used for assessments. • If you have not already signed up to receive the Raise NC Newsletter, now is the time as new information on the QRIS will be shared in upcoming newsletters. • You confirmed with me today that your email address is: makedwards901@gmail.com. • Ms. Edwards stated that Ms. Resendiz has completed the ABMS process and staff are on the roster. • We discussed staff with medication and storage. • We also discussed some of the changes to the new ITERS-3 and ECERS-3. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/2/2025 Number Present: 34 Completed Date: 7/2/2025 Age: From 0 To 11 Total Minutes: 210 Time In: 09:45 AM Time Out: 01:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted with Makayla Edwards, the Administrator. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 06/25/25 and Learning Tree Childcare Center, LLC was listed as current and active. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children having outdoor gross motor play, preparing for and having lunch. Infants were having their individual needs met. I observed materials and activities that were available to the children in the classrooms. Your facility uses the Brightwheel “Experience” curriculum. The last annual compliance visit was conducted on 7/9/24. A sanitation inspection was completed 6/18/25 with a Superior classification and thirteen (13) demerits. The last fire inspection was conducted on 3/10/25. A copy was received today on the visit. Program records and required postings were monitored. A fire drill was conducted on 6/18/25 at 9:59 am with two (2) minutes three (3) seconds to evacuate thirty-seven (37) children and eight (8) adults by M. Edwards. A shelter in place drill was documented on 6/20/25 at 3:15 pm with fifty-eight (58) seconds to shelter-in-place by M. Edwards. An outdoor inspection was documented on 7/1/25 by M. Edwards. Two (2) new staff files and one (1) other staff file and four (4) children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Hazardous items were stored in locked closets. Storage and administration of medication were monitored. Medication authorization was monitored. One (1) ADHD medication was monitored with required paperwork today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 807 A safe indoor and outdoor environment was not provided for the children. The door to the playground from the inside hallway of the building has a wooden frame that is broken at the bottom left of the outside door. This door frame will need repair. The back gate to the back side of the building must have a carabiner lock to prevent children from going outside since the latch is low and accessible to children. The two (2) red musical instruments on the playgrounds have the footings exposed which is a tripping/fall hazard to children and or staff. Ground cover was exposed through the blue mulch causing a tripping hazard. 10A NCAC 09 .0601(a) You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Wednesday, July 16, 2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to: karen.young@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action being taken by the DCDEE. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit related to violations: • A safe indoor and outdoor environment is required where children are in care to prevent tripping, falling, or getting out of a fenced area. Refer to Childcare Rule 10A NCAC .09 .? Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The QRIS is being implemented, and I will keep you updated as more information is shared with consultants. • ITERS-3 & ECERS-3 are now being used for assessments. • If you have not already signed up to receive the Raise NC Newsletter, now is the time as new information on the QRIS will be shared in upcoming newsletters. • You confirmed with me today that your email address is: makedwards901@gmail.com. • Ms. Edwards stated that Ms. Resendiz has completed the ABMS process and staff are on the roster. • We discussed staff with medication and storage. • We also discussed some of the changes to the new ITERS-3 and ECERS-3. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0510 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 0225-228L Visit Date: 3/10/2025 Number Present: 23 Completed Date: 3/10/2025 Age: From 0 To 4 Total Minutes: 160 Time In: 09:35 AM Time Out: 12:15 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant, and Pam Hauser, Supervisor, with Makayla Edwards, Director. Ms. Heather Resendiz, Owner was called on the phone by Ms. Edwards to let her know the nature of this visit. The allegations are as follows: There are concerns that: Activities are not developmentally appropriate. Lesson plans are not followed. Circle time is omitted. Children have screen time beyond what is allowed. Children are not treated in a nurturing and caring manner. Some teachers are “mean” to the children and lack patience with the children. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve years old and is approved to operate five classrooms. Heather Resendiz is the sole proprietor of this center. The program’s compliance history was 85% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: There is a concern regarding activities are not developmentally appropriate. Lesson plans are not followed. Circle time is omitted. Children have screen time beyond what is allowed. Observation #1: During today’s visit, we viewed lesson/activity plans and materials for each classroom related to their activity plans. The center has purchased and is using the Bright wheel curriculum for children ages two and up. Today during the visit, we observed circle time in the 1- & 2-year-old classroom and in the 3 - & 4-year-old classroom. The children and teachers were engaged, as they read books and discussed today’s topics. We observed the curriculum lesson plans were posted and current. We observed materials were available that coincide with the lesson plans. Ms. Edwards stated she and the owner have discouraged any type of screen time. Ms. Edwards stated children are allowed to use screen time for homework if they choose. The screen time log for school age children has not been documented since June of 2024. Ms. Edwards has blank screen time logs available in the classroom. The screen time log should should reflect when children use screen time to complete their homework assignments daily, free choices and a developmental goal. The two-year-old teacher stated that they do not do screen time. During today’s visit, we did not observe any screentime. Conclusion #1: Based on the above information and observations during today’s visit, this allegation was unsubstantiated. Allegation #2: There is a concern regarding children are not treated in a nurturing and caring manner. Some teachers are “mean” to the children and lack patience with the children. Observation #2: During today’s visit we observed children in classrooms engaged in circle time and activities. All children were attended to in a nurturing and caring manner during the visit. We observed teachers engaged with the children and developmentally appropriate activities during the visit today. In the infant room, we observed the infants on the rug engaged with the teacher holding them and spontaneously reading to the infants. Conclusion #2: Based on the above information and observations during today’s visit, there was not enough information to support the allegation. This allegation was unsubstantiated. One violations was cited at today’s visit. Violation Number Comment Rule 539 When screen time was provided to school-aged children, it was not offered as a free-choice activity; not used to meet a developmental goal; was not limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and/or was not documented on a cumulative log or the activity plan that is available for review. The screen time log was not documented for school age children. The last documentation of screen time was June 2024. .2508(e)(1-5) The following violations were cited during today’s visit: Comments Section – Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Monday March 24, 2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance. Too much screen time can make it hard for children to sleep, and increase their risk of anxiety, depression, and obesity. Too much screen time can lead to learning and sleep problems excessive screen time and sleep deprivation are linked to obesity and too much time on social media can affect behavior and cognitive performance in school Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Screen time for school age children must be documented on the screen time log for free choice, homework, or developmental goals. • 10A NCAC 09 .0510 (f) Screen Time- Screen time, including television, videos, video games, and computer usage, shall be prohibited for children under three years of age. When preschool children three years old and older are in care the following shall apply: 10A NCAC 09 .0510(d)(2) when screen time is provided on any electronic media device with a visual display, it shall be: offered to stimulate a developmental domain in accordance with the North Carolina Foundations for Early Learning and Development as referenced in Rule .0508 of this Section; limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and documented on a cumulative log or the activity plan that shall be available for review by the Division. • All staff must have documentation of education on file at the center. • CPR/First Aid does not count toward annual on-going training. • We reviewed 10 NCAC 09 .0701 Pre-Service Requirements with the Director today. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 817-2689 Karen.young@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 0225-228L Visit Date: 3/10/2025 Number Present: 23 Completed Date: 3/10/2025 Age: From 0 To 4 Total Minutes: 160 Time In: 09:35 AM Time Out: 12:15 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant, and Pam Hauser, Supervisor, with Makayla Edwards, Director. Ms. Heather Resendiz, Owner was called on the phone by Ms. Edwards to let her know the nature of this visit. The allegations are as follows: There are concerns that: Activities are not developmentally appropriate. Lesson plans are not followed. Circle time is omitted. Children have screen time beyond what is allowed. Children are not treated in a nurturing and caring manner. Some teachers are “mean” to the children and lack patience with the children. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve years old and is approved to operate five classrooms. Heather Resendiz is the sole proprietor of this center. The program’s compliance history was 85% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: There is a concern regarding activities are not developmentally appropriate. Lesson plans are not followed. Circle time is omitted. Children have screen time beyond what is allowed. Observation #1: During today’s visit, we viewed lesson/activity plans and materials for each classroom related to their activity plans. The center has purchased and is using the Bright wheel curriculum for children ages two and up. Today during the visit, we observed circle time in the 1- & 2-year-old classroom and in the 3 - & 4-year-old classroom. The children and teachers were engaged, as they read books and discussed today’s topics. We observed the curriculum lesson plans were posted and current. We observed materials were available that coincide with the lesson plans. Ms. Edwards stated she and the owner have discouraged any type of screen time. Ms. Edwards stated children are allowed to use screen time for homework if they choose. The screen time log for school age children has not been documented since June of 2024. Ms. Edwards has blank screen time logs available in the classroom. The screen time log should should reflect when children use screen time to complete their homework assignments daily, free choices and a developmental goal. The two-year-old teacher stated that they do not do screen time. During today’s visit, we did not observe any screentime. Conclusion #1: Based on the above information and observations during today’s visit, this allegation was unsubstantiated. Allegation #2: There is a concern regarding children are not treated in a nurturing and caring manner. Some teachers are “mean” to the children and lack patience with the children. Observation #2: During today’s visit we observed children in classrooms engaged in circle time and activities. All children were attended to in a nurturing and caring manner during the visit. We observed teachers engaged with the children and developmentally appropriate activities during the visit today. In the infant room, we observed the infants on the rug engaged with the teacher holding them and spontaneously reading to the infants. Conclusion #2: Based on the above information and observations during today’s visit, there was not enough information to support the allegation. This allegation was unsubstantiated. One violations was cited at today’s visit. Violation Number Comment Rule 539 When screen time was provided to school-aged children, it was not offered as a free-choice activity; not used to meet a developmental goal; was not limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and/or was not documented on a cumulative log or the activity plan that is available for review. The screen time log was not documented for school age children. The last documentation of screen time was June 2024. .2508(e)(1-5) The following violations were cited during today’s visit: Comments Section – Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Monday March 24, 2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical Assistance. Too much screen time can make it hard for children to sleep, and increase their risk of anxiety, depression, and obesity. Too much screen time can lead to learning and sleep problems excessive screen time and sleep deprivation are linked to obesity and too much time on social media can affect behavior and cognitive performance in school Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Screen time for school age children must be documented on the screen time log for free choice, homework, or developmental goals. • 10A NCAC 09 .0510 (f) Screen Time- Screen time, including television, videos, video games, and computer usage, shall be prohibited for children under three years of age. When preschool children three years old and older are in care the following shall apply: 10A NCAC 09 .0510(d)(2) when screen time is provided on any electronic media device with a visual display, it shall be: offered to stimulate a developmental domain in accordance with the North Carolina Foundations for Early Learning and Development as referenced in Rule .0508 of this Section; limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and documented on a cumulative log or the activity plan that shall be available for review by the Division. • All staff must have documentation of education on file at the center. • CPR/First Aid does not count toward annual on-going training. • We reviewed 10 NCAC 09 .0701 Pre-Service Requirements with the Director today. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 817-2689 Karen.young@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1802 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1803 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2510 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: 1124-132L Visit Date: 11/25/2024 Number Present: 38 Completed Date: 11/25/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 12:45 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 childcare requirements. This visit was conducted by Karen Young, childcare consultant with Makayla Edwards, Director. Ms. Edwards called Ms. Resendiz, owner, to give her the information that I was at the center today for a complaint. I spoke with Ms. Resendiz over the phone to explain why I was at the center today. Allegations are as follows: There are concerns that: Groups are out of ratio during morning drop off. A teacher vapes in front of the children. A 17-year-old girl is left in charge of a group of children. Handwashing does not occur as required. (staff and children) Children are not treated in a nurturing and caring manner. During today’s visit, the allegations were discussed with you. You had the opportunity to respond. Information shared during this visit is documented in this visit summary. Your program currently operates with a Three (3) Star license effective 1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care for children aged zero to twelve-years-old and is approved to operate five classrooms. The program’s compliance history was 100% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • Adequate / Approved Space • License Posted • Permit Restrictions Allegation #1: Groups are out of ratio during morning drop off. Observation #1: Time cards were printed for me by M. Edwards, Director today. I interviewed staff regarding who arrives and at what time each day. M. Edwards stated that there are no schedules set for staff. They have a group chat and discuss the previous day and/or over group chat what time each staff will arrive. There are set morning and afternoon staff but no set arrival and departure time for staff daily. They can leave as ratios allow but not before Ms. Edwards stated. Ms. Edwards stated that some of the children are part-time and they change times based on how many children will be in attendance each day. Based on the print out of the student count, staff count, and student to staff-ratios by room, that Ms. Edwards printed out for me, there is no evidence of staff being out of ratio in the mornings. The regular morning staff at 6:30 am are: H. Bare, F. Morales, L. Turner (for 1 hour, until she goes to school at 7:30 am). Kayla Edwards arrives at 7:30 am. If Ms. Edwards knows that ratios are going to be tight, she stated that she drops her children at school at 7 am and come straight on to the center. Conclusion #1: Based on the above information and observations during today’s visit, there was no evidence of staff being out of ratio in the mornings during the time of 6:30 am to 7:45 am. This allegation is unsubstantiated. Allegation #2: A teacher vapes in front of the children. Observation #2: During today’s visit, I interviewed all seven (7) staff. Staff stated they know there are staff members that vape. No one reported seeing staff members vape on the premises and all staff interviewed stated that they had not observed any staff vaping in front of children. Staff reported they know they must leave the premises to vape. Conclusion #2: There was no evidence of staff members vaping in front of the children. This allegation is unsubstantiated. Allegation #3: A 17-year-old girl is left in charge of a group of children. Observation #3: After reviewing the student count, staff count, and student -to- staff ratios by room printed out, there was not ever a time that a 17-year-old girl was left in charge of a group of children. There is a 17-year-old girl that comes with her mother daily from 6:30-7:30. Staff were asked if there was ever a time when a 17- year- old staff member was left alone with children and the answer was never left alone, but they were with another staff member. Conclusion #3: Based on the information provided today and the interviews with all seven (7) staff members, there is no evidence that a 17-year-old girl was left in charge of a group of children. This allegation ius unsubstantiated. Allegation #4: Handwashing does not occur as required. (staff and children) Observation #4: I observed a two -year-old child that did not wash hands after getting off the changing table. I observed an open bag of pretzels on the children’s table. One child came over to the table after washing his hands, sat down at the table and began to put his hands in the pretzel bag to eat the pretzels. The staff member did not see this happening as she had her back to the child at the table while she was assisting other children with handwashing. I told the teacher about this, and she discarded the open bag of pretzels and got an unopened bag to give to the children. When asked if she cleans and sanitizes the tables, she stated that she had already done that while children were sleeping, prior to me coming into the room for the sanitizing solution to be able to dry. Conclusion #4: Based on observations today, this violation is substantiated as one child did not wash hands after leaving the changing table and the child was eating pretzels out of the open bag which contaminated the bag for the other children. Allegation #5: Children are not treated in a nurturing and caring manner. Observation #5: After interviewing all seven(7) staff today, it was reported they had not heard any cursing at the center nor anyone treating children in an unacceptable manner by yelling or raising their voices at the children. I did not hear anything unacceptable during my visit today. Conclusion #5: Based on interviews with the staff and my own observations today, this violation is unsubstantiated. The following violations were cited at today’s visit: Violation Number Comment Rule 608 Children did not wash their hands upon arrival at the center, after each visit to the toilet, before eating, before and after water activity play, after outside play, and after handling animals or animal cages. I observed a two-year-old child get off the changing table and not wash their hands. Another child went over to the snack table, after washing their hands, sat down, and began to put their hands in the open pretzel bag that was on the table, and began to eat the pretzels. The staff member did not see this happening as she was assisting other children with handwashing and had her back to the child at the table. The consultant made the teacher aware of this situation and the teacher then discarded the open bag of pretzels and retrieved an unopened bag to give to the children for a snack. 15A NCAC 18A .2803(c) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. I observed two (2) new staff today that did not a medical statement in their file. 10A NCAC 09 .0701(a) 1034 All staff, including the director, did not have an annual health questionnaire on file following the initial medical statement. I observed one staff who did have a health questionnaire on file. .0701(a) 1035 Child care providers, including the director, uncompensated providers, substitute providers, and volunteers did not have the required Emergency Information Form on file on or before the first day of work, which included all the required information and/or the information on the form was not updated as changes occur and at least annually.I observed one staff who did not have emergency information on file today. .0701(a) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. New staff member in charge of school age children today did not have BSAC qualifications. 10A NCAC 09 .2510(f) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. I observed three (3) staff who did not have the certification of SBAHT in their file today. .0608(d)(1-4) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. I observed three (3) new staff who did not have proof of a TB screening in their file today. .0701(d) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct your violations and send me a letter of compliance within two (2) weeks which will be due on or before December 9, 2024. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action being taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • See Child Care Rule 10A NCAC 09 .1803 – Prohibited discipline, specifically .1803(9). • See Child Care Rule 10A NCAC 09 .1801 – Supervision in child care centers • See Child Care Rule 10A NCAC 09 .1802 – Staff/child interactions • See Child Care Rule 10A NCAC 09 .2830 – Maintaining the star rating, specifically .2830(c), & .0703 – Staff Qualifications. The above Child Care rules were shared with Ms. Edwards and Ms. Resendiz after the complaint visit on 11/5/24. Ms. Edwards stated she and Ms. Resendiz have been in conversation about scheduling an all staff meeting now that new staff have been hired. They are still searching for a cook so that Ms. Edwards could be freer for administrative duties and assistance in the classrooms. Technical assistance added today: • Based on the email response back from the Division today, L. Turner did not turn in fingerprints so her status is “new application must be submitted”. I stated to Ms. Edwards that L. Turner could no longer work at the center until she has received a completed Criminal background check (CBC) back from the Division. • See Sanitation Rules on the DCDEE website regarding washing hands, sanitizing tables, and food preparation. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The cohorts no longer exist. • You are encouraged to visit NCRLAP website and look at “connecting with the Three’s”. ECERS-R and ITERS-R are being replaced with ITERS-3 and ECERS-3 beginning 2/1/25. • The new QRIS (Quality Rating Improvement System) is being implemented. I will share more information once we have been trained on the QRIS. • You may want to reach out to your local Alleghany Partnership for children for additional assistance. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336)207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/9/2024 Number Present: 33 Completed Date: 7/9/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Karen Young, Childcare Consultant with Makayla Edwards, Director. Your program currently operates with a Three (3) Star license effective1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 7/9/24 and Learning Tree Child Care Center, LLC was listed as current and active. The program’s compliance history was 83% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed positive interactions today. I observed children playing on the porch, having free choice center time, and infants were having individual needs met. I observed developmentally appropriate materials and activities were available to the children in the classrooms. Your facility uses Creative Curriculum. The last temporary time period visit was conducted on 1/4/24. This is your first annual compliance visit. A sanitation inspection was completed 4/22/24 with an Approved classification and twenty-one (21) demerits. The last fire inspection was conducted 12/1/23 by Daniel Roten. Program records and required postings were monitored. A fire drill was conducted on 6/18/24 at 3:17 pm with two (2) minutes and twelve (12) seconds to evacuate forty-five (45) children and ten (10) adults by M. Edwards. A lockdown drill was documented on 4/12/24 at 2:15 pm with three (3) minutes and seventeen (17) seconds to lockdown. An outdoor inspection was documented on 7/1/24 with trash and black liner showing through mulch noted on the inspection form. Staff files and children’s records were monitored per DCDEE procedures. I observed five (5) children’s files during today’s visit and two (2) staff files during today’s visit. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. I observed over the counter sunscreens and diaper creams and ointments today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. I observed one baby bottle in Space 3 that was not labeled with a name or dated. 15A NCAC 18A .2804(d) 807 A safe indoor and outdoor environment was not provided for the children. I observed exposed ground cover at the bottom of the steps going into the hallway, which is a tripping hazard for children and adults. 10A NCAC 09 .0601(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. I observed an outlet without a protective cover in Space 1. This was corrected during the visit today. 10A NCAC 09 .0604(c) 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. I observed an areosol spray can of butter in the kitchen that was not locked away. This was corrected during the visit. .2820(b) 847 Parent's medication authorization did not include required information. I observed permission to administer medication that did not include the name of the sunscreen product. I observed the permission to administer sunscreen did not include the amount to be administered on the form. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. I observed the safe sleep checks were not conducted for any of the month of July, 2024. 10A NCAC 09 .0606(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Tuesday, July 23, 2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs,nc.gov@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance provided during today’s visit: • Tripping hazards are dangerous to the children and staff of the center. Please be sure all ground cover material is covered by the mulch. This can prevent a tripping hazard. See child care rule .0601(a) • All outlets must be covered with outlet cover protectors to prevent electrical shock in children. See child care rule .0604(c). • All aerosol sprays must be locked away, including any aerosol sprays in the kitchen area. See Sanitation Rule .15A NCAC 18A .2820(b). • Safe sleep checks must be conducted every fifteen (15) minutes as your safe sleep policy indicates will happen. This is extremely important to prevent SIDS (sudden infant death syndrome) in infants 0 to 12 months of age, and to monitored sleep patterns in infants. See child care rule .0606 (a). • Names of the sunscreen product must be included on the permission to administer forms. Also, when using your own forms, they must include all the information that is provided on the DCDEE permission to administer forms, including the amount to be given on your sunscreen form. See childcare rule .0803(4) & (6-9). • Daily label baby bottles with name and date to prevent confusion in distributing the bottles to infants. See sanitation rule 15A NCAC 18A .2804(d). Consultation during today’s visit included: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Update your safe sleep policy in children’s files to reflect the specific marked policies your center follows. • Provide a larger rug in the block areas to help with noise levels in Space 1. • There is an updated Summary of the Law on the DCDEE website under Provider > forms and documents > scroll to Summary of the Law and print. • Schedule EPR training for all your staff to be led by H. Resendiz since she has taken the training. • General cleaning of stuffed animals, cushions, boppy seats, and rugs, etc. is needed to keep down the spread of germs in a childcare center and to maintain a healthy environment for the children and staff. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/9/2024 Number Present: 33 Completed Date: 7/9/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Karen Young, Childcare Consultant with Makayla Edwards, Director. Your program currently operates with a Three (3) Star license effective1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 7/9/24 and Learning Tree Child Care Center, LLC was listed as current and active. The program’s compliance history was 83% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed positive interactions today. I observed children playing on the porch, having free choice center time, and infants were having individual needs met. I observed developmentally appropriate materials and activities were available to the children in the classrooms. Your facility uses Creative Curriculum. The last temporary time period visit was conducted on 1/4/24. This is your first annual compliance visit. A sanitation inspection was completed 4/22/24 with an Approved classification and twenty-one (21) demerits. The last fire inspection was conducted 12/1/23 by Daniel Roten. Program records and required postings were monitored. A fire drill was conducted on 6/18/24 at 3:17 pm with two (2) minutes and twelve (12) seconds to evacuate forty-five (45) children and ten (10) adults by M. Edwards. A lockdown drill was documented on 4/12/24 at 2:15 pm with three (3) minutes and seventeen (17) seconds to lockdown. An outdoor inspection was documented on 7/1/24 with trash and black liner showing through mulch noted on the inspection form. Staff files and children’s records were monitored per DCDEE procedures. I observed five (5) children’s files during today’s visit and two (2) staff files during today’s visit. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. I observed over the counter sunscreens and diaper creams and ointments today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. I observed one baby bottle in Space 3 that was not labeled with a name or dated. 15A NCAC 18A .2804(d) 807 A safe indoor and outdoor environment was not provided for the children. I observed exposed ground cover at the bottom of the steps going into the hallway, which is a tripping hazard for children and adults. 10A NCAC 09 .0601(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. I observed an outlet without a protective cover in Space 1. This was corrected during the visit today. 10A NCAC 09 .0604(c) 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. I observed an areosol spray can of butter in the kitchen that was not locked away. This was corrected during the visit. .2820(b) 847 Parent's medication authorization did not include required information. I observed permission to administer medication that did not include the name of the sunscreen product. I observed the permission to administer sunscreen did not include the amount to be administered on the form. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. I observed the safe sleep checks were not conducted for any of the month of July, 2024. 10A NCAC 09 .0606(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Tuesday, July 23, 2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs,nc.gov@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance provided during today’s visit: • Tripping hazards are dangerous to the children and staff of the center. Please be sure all ground cover material is covered by the mulch. This can prevent a tripping hazard. See child care rule .0601(a) • All outlets must be covered with outlet cover protectors to prevent electrical shock in children. See child care rule .0604(c). • All aerosol sprays must be locked away, including any aerosol sprays in the kitchen area. See Sanitation Rule .15A NCAC 18A .2820(b). • Safe sleep checks must be conducted every fifteen (15) minutes as your safe sleep policy indicates will happen. This is extremely important to prevent SIDS (sudden infant death syndrome) in infants 0 to 12 months of age, and to monitored sleep patterns in infants. See child care rule .0606 (a). • Names of the sunscreen product must be included on the permission to administer forms. Also, when using your own forms, they must include all the information that is provided on the DCDEE permission to administer forms, including the amount to be given on your sunscreen form. See childcare rule .0803(4) & (6-9). • Daily label baby bottles with name and date to prevent confusion in distributing the bottles to infants. See sanitation rule 15A NCAC 18A .2804(d). Consultation during today’s visit included: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Update your safe sleep policy in children’s files to reflect the specific marked policies your center follows. • Provide a larger rug in the block areas to help with noise levels in Space 1. • There is an updated Summary of the Law on the DCDEE website under Provider > forms and documents > scroll to Summary of the Law and print. • Schedule EPR training for all your staff to be led by H. Resendiz since she has taken the training. • General cleaning of stuffed animals, cushions, boppy seats, and rugs, etc. is needed to keep down the spread of germs in a childcare center and to maintain a healthy environment for the children and staff. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0606 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/9/2024 Number Present: 33 Completed Date: 7/9/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Karen Young, Childcare Consultant with Makayla Edwards, Director. Your program currently operates with a Three (3) Star license effective1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 7/9/24 and Learning Tree Child Care Center, LLC was listed as current and active. The program’s compliance history was 83% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed positive interactions today. I observed children playing on the porch, having free choice center time, and infants were having individual needs met. I observed developmentally appropriate materials and activities were available to the children in the classrooms. Your facility uses Creative Curriculum. The last temporary time period visit was conducted on 1/4/24. This is your first annual compliance visit. A sanitation inspection was completed 4/22/24 with an Approved classification and twenty-one (21) demerits. The last fire inspection was conducted 12/1/23 by Daniel Roten. Program records and required postings were monitored. A fire drill was conducted on 6/18/24 at 3:17 pm with two (2) minutes and twelve (12) seconds to evacuate forty-five (45) children and ten (10) adults by M. Edwards. A lockdown drill was documented on 4/12/24 at 2:15 pm with three (3) minutes and seventeen (17) seconds to lockdown. An outdoor inspection was documented on 7/1/24 with trash and black liner showing through mulch noted on the inspection form. Staff files and children’s records were monitored per DCDEE procedures. I observed five (5) children’s files during today’s visit and two (2) staff files during today’s visit. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. I observed over the counter sunscreens and diaper creams and ointments today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. I observed one baby bottle in Space 3 that was not labeled with a name or dated. 15A NCAC 18A .2804(d) 807 A safe indoor and outdoor environment was not provided for the children. I observed exposed ground cover at the bottom of the steps going into the hallway, which is a tripping hazard for children and adults. 10A NCAC 09 .0601(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. I observed an outlet without a protective cover in Space 1. This was corrected during the visit today. 10A NCAC 09 .0604(c) 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. I observed an areosol spray can of butter in the kitchen that was not locked away. This was corrected during the visit. .2820(b) 847 Parent's medication authorization did not include required information. I observed permission to administer medication that did not include the name of the sunscreen product. I observed the permission to administer sunscreen did not include the amount to be administered on the form. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. I observed the safe sleep checks were not conducted for any of the month of July, 2024. 10A NCAC 09 .0606(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Tuesday, July 23, 2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs,nc.gov@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance provided during today’s visit: • Tripping hazards are dangerous to the children and staff of the center. Please be sure all ground cover material is covered by the mulch. This can prevent a tripping hazard. See child care rule .0601(a) • All outlets must be covered with outlet cover protectors to prevent electrical shock in children. See child care rule .0604(c). • All aerosol sprays must be locked away, including any aerosol sprays in the kitchen area. See Sanitation Rule .15A NCAC 18A .2820(b). • Safe sleep checks must be conducted every fifteen (15) minutes as your safe sleep policy indicates will happen. This is extremely important to prevent SIDS (sudden infant death syndrome) in infants 0 to 12 months of age, and to monitored sleep patterns in infants. See child care rule .0606 (a). • Names of the sunscreen product must be included on the permission to administer forms. Also, when using your own forms, they must include all the information that is provided on the DCDEE permission to administer forms, including the amount to be given on your sunscreen form. See childcare rule .0803(4) & (6-9). • Daily label baby bottles with name and date to prevent confusion in distributing the bottles to infants. See sanitation rule 15A NCAC 18A .2804(d). Consultation during today’s visit included: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Update your safe sleep policy in children’s files to reflect the specific marked policies your center follows. • Provide a larger rug in the block areas to help with noise levels in Space 1. • There is an updated Summary of the Law on the DCDEE website under Provider > forms and documents > scroll to Summary of the Law and print. • Schedule EPR training for all your staff to be led by H. Resendiz since she has taken the training. • General cleaning of stuffed animals, cushions, boppy seats, and rugs, etc. is needed to keep down the spread of germs in a childcare center and to maintain a healthy environment for the children and staff. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/9/2024 Number Present: 33 Completed Date: 7/9/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Karen Young, Childcare Consultant with Makayla Edwards, Director. Your program currently operates with a Three (3) Star license effective1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 7/9/24 and Learning Tree Child Care Center, LLC was listed as current and active. The program’s compliance history was 83% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed positive interactions today. I observed children playing on the porch, having free choice center time, and infants were having individual needs met. I observed developmentally appropriate materials and activities were available to the children in the classrooms. Your facility uses Creative Curriculum. The last temporary time period visit was conducted on 1/4/24. This is your first annual compliance visit. A sanitation inspection was completed 4/22/24 with an Approved classification and twenty-one (21) demerits. The last fire inspection was conducted 12/1/23 by Daniel Roten. Program records and required postings were monitored. A fire drill was conducted on 6/18/24 at 3:17 pm with two (2) minutes and twelve (12) seconds to evacuate forty-five (45) children and ten (10) adults by M. Edwards. A lockdown drill was documented on 4/12/24 at 2:15 pm with three (3) minutes and seventeen (17) seconds to lockdown. An outdoor inspection was documented on 7/1/24 with trash and black liner showing through mulch noted on the inspection form. Staff files and children’s records were monitored per DCDEE procedures. I observed five (5) children’s files during today’s visit and two (2) staff files during today’s visit. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. I observed over the counter sunscreens and diaper creams and ointments today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. I observed one baby bottle in Space 3 that was not labeled with a name or dated. 15A NCAC 18A .2804(d) 807 A safe indoor and outdoor environment was not provided for the children. I observed exposed ground cover at the bottom of the steps going into the hallway, which is a tripping hazard for children and adults. 10A NCAC 09 .0601(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. I observed an outlet without a protective cover in Space 1. This was corrected during the visit today. 10A NCAC 09 .0604(c) 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. I observed an areosol spray can of butter in the kitchen that was not locked away. This was corrected during the visit. .2820(b) 847 Parent's medication authorization did not include required information. I observed permission to administer medication that did not include the name of the sunscreen product. I observed the permission to administer sunscreen did not include the amount to be administered on the form. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. I observed the safe sleep checks were not conducted for any of the month of July, 2024. 10A NCAC 09 .0606(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Tuesday, July 23, 2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs,nc.gov@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance provided during today’s visit: • Tripping hazards are dangerous to the children and staff of the center. Please be sure all ground cover material is covered by the mulch. This can prevent a tripping hazard. See child care rule .0601(a) • All outlets must be covered with outlet cover protectors to prevent electrical shock in children. See child care rule .0604(c). • All aerosol sprays must be locked away, including any aerosol sprays in the kitchen area. See Sanitation Rule .15A NCAC 18A .2820(b). • Safe sleep checks must be conducted every fifteen (15) minutes as your safe sleep policy indicates will happen. This is extremely important to prevent SIDS (sudden infant death syndrome) in infants 0 to 12 months of age, and to monitored sleep patterns in infants. See child care rule .0606 (a). • Names of the sunscreen product must be included on the permission to administer forms. Also, when using your own forms, they must include all the information that is provided on the DCDEE permission to administer forms, including the amount to be given on your sunscreen form. See childcare rule .0803(4) & (6-9). • Daily label baby bottles with name and date to prevent confusion in distributing the bottles to infants. See sanitation rule 15A NCAC 18A .2804(d). Consultation during today’s visit included: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Update your safe sleep policy in children’s files to reflect the specific marked policies your center follows. • Provide a larger rug in the block areas to help with noise levels in Space 1. • There is an updated Summary of the Law on the DCDEE website under Provider > forms and documents > scroll to Summary of the Law and print. • Schedule EPR training for all your staff to be led by H. Resendiz since she has taken the training. • General cleaning of stuffed animals, cushions, boppy seats, and rugs, etc. is needed to keep down the spread of germs in a childcare center and to maintain a healthy environment for the children and staff. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

NC GS 110-90 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: KAREN YOUNG Operation Type: Center Case Number: Visit Date: 7/9/2024 Number Present: 33 Completed Date: 7/9/2024 Age: From 0 To 12 Total Minutes: 240 Time In: 10:00 AM Time Out: 02:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Karen Young, Childcare Consultant with Makayla Edwards, Director. Your program currently operates with a Three (3) Star license effective1/15/24. Restrictions include daytime care only and children under 2 ½ years old in rooms with direct exits only. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate five classrooms. The license was observed, and the restrictions were found in compliance. The NC Secretary of State website was reviewed on 7/9/24 and Learning Tree Child Care Center, LLC was listed as current and active. The program’s compliance history was 83% prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed positive interactions today. I observed children playing on the porch, having free choice center time, and infants were having individual needs met. I observed developmentally appropriate materials and activities were available to the children in the classrooms. Your facility uses Creative Curriculum. The last temporary time period visit was conducted on 1/4/24. This is your first annual compliance visit. A sanitation inspection was completed 4/22/24 with an Approved classification and twenty-one (21) demerits. The last fire inspection was conducted 12/1/23 by Daniel Roten. Program records and required postings were monitored. A fire drill was conducted on 6/18/24 at 3:17 pm with two (2) minutes and twelve (12) seconds to evacuate forty-five (45) children and ten (10) adults by M. Edwards. A lockdown drill was documented on 4/12/24 at 2:15 pm with three (3) minutes and seventeen (17) seconds to lockdown. An outdoor inspection was documented on 7/1/24 with trash and black liner showing through mulch noted on the inspection form. Staff files and children’s records were monitored per DCDEE procedures. I observed five (5) children’s files during today’s visit and two (2) staff files during today’s visit. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. I observed over the counter sunscreens and diaper creams and ointments today. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 533 Human milk, formula and other bottled beverages including sippy cups, sent from child's home were not fully prepared, dated, and labeled for the appropriate child. I observed one baby bottle in Space 3 that was not labeled with a name or dated. 15A NCAC 18A .2804(d) 807 A safe indoor and outdoor environment was not provided for the children. I observed exposed ground cover at the bottom of the steps going into the hallway, which is a tripping hazard for children and adults. 10A NCAC 09 .0601(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. I observed an outlet without a protective cover in Space 1. This was corrected during the visit today. 10A NCAC 09 .0604(c) 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. I observed an areosol spray can of butter in the kitchen that was not locked away. This was corrected during the visit. .2820(b) 847 Parent's medication authorization did not include required information. I observed permission to administer medication that did not include the name of the sunscreen product. I observed the permission to administer sunscreen did not include the amount to be administered on the form. 10A NCAC 09 .0803(4)(6-9) 871 Center staff did not comply with the safe sleep policy. I observed the safe sleep checks were not conducted for any of the month of July, 2024. 10A NCAC 09 .0606(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 110-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before Tuesday, July 23, 2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to karen.young@dhhs,nc.gov@dhhs.nc.gov or mail two copies of the letter to: Karen Young P.O. Box 1012 Lewisville, NC 27023 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance provided during today’s visit: • Tripping hazards are dangerous to the children and staff of the center. Please be sure all ground cover material is covered by the mulch. This can prevent a tripping hazard. See child care rule .0601(a) • All outlets must be covered with outlet cover protectors to prevent electrical shock in children. See child care rule .0604(c). • All aerosol sprays must be locked away, including any aerosol sprays in the kitchen area. See Sanitation Rule .15A NCAC 18A .2820(b). • Safe sleep checks must be conducted every fifteen (15) minutes as your safe sleep policy indicates will happen. This is extremely important to prevent SIDS (sudden infant death syndrome) in infants 0 to 12 months of age, and to monitored sleep patterns in infants. See child care rule .0606 (a). • Names of the sunscreen product must be included on the permission to administer forms. Also, when using your own forms, they must include all the information that is provided on the DCDEE permission to administer forms, including the amount to be given on your sunscreen form. See childcare rule .0803(4) & (6-9). • Daily label baby bottles with name and date to prevent confusion in distributing the bottles to infants. See sanitation rule 15A NCAC 18A .2804(d). Consultation during today’s visit included: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • Update your safe sleep policy in children’s files to reflect the specific marked policies your center follows. • Provide a larger rug in the block areas to help with noise levels in Space 1. • There is an updated Summary of the Law on the DCDEE website under Provider > forms and documents > scroll to Summary of the Law and print. • Schedule EPR training for all your staff to be led by H. Resendiz since she has taken the training. • General cleaning of stuffed animals, cushions, boppy seats, and rugs, etc. is needed to keep down the spread of germs in a childcare center and to maintain a healthy environment for the children and staff. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Karen Young, Child Care Consultant (336) 207-2151 karen.young@dhh.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0302 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: 1223-238L Visit Date: 1/4/2024 Number Present: 41 Completed Date: 1/5/2024 Age: From 0 To 12 Total Minutes: 100 Time In: 01:50 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding allegations of violations of child care requirements for program record keeping, medication, and nutrition for infants and toddlers. The visit was conducted with Makayla Edwards, Interim Director, and Heather Resendiz, Owner, by Tammy Burcham, Lead Child Care Consultant. Ms. Edwards accompanied Ms. Childress in a walk-through of the facility and children in care were observed to be engaged in nap time and personal care routines. In addition to alleged violations of child care requirements, staff/child ratios, supervision, adequate/approved space, the license posted, and license restrictions were also monitored. On December 18, 2023, Ms. Resendiz contacted Ms. Childress and provided information regarding some of the allegations. Ms. Resendiz, per the instruction of Ms. Childress, also contacted the intake unit of the Division of Child Development and Early Education, to self-report incidents that had occurred. In addition, Ms. Resendiz submitted documentation of conversations between staff and a parent, a photograph, and other information she felt was pertinent. At that time, all information received did not constitute an investigation. Allegations were discussed with Ms. Edwards, Ms. Resendiz and two additional staff members, Tori Brown, and Jennifer Galyean, during today’s visit. Violation Number Comment Rule 542 The written feeding plan was not modified as the child's needs changed. An infant's feeding plan was not modified on December 4, 2023, to add specific times for bottle feedings and baby food feedings and posted for reference by caregivers. The feeding plan posted in the classroom was signed by the parent and dated July 12, 2023. 10 NCAC 09 .0902(a) 853 Incident logs were not completed and maintained as required. An incident report dated December 5, 2023, was not entered on incident log. .0802(g)(1-6) 1952 A copy of the incident report was not given to the parent. An incident report dated December 5, 2023 was not provided to a parent nor a parent signature declining a copy of the report obtained. .0802(e) The following information was received through staff interviews, documentation, and observations during today’s visit: •It is alleged that an infant’s meal plan was not followed. Ms. Brown and Ms. Galyean stated that the child ate well, and they fed the child as the parent requested. They both gave the child bottles and baby food, but once the baby food was introduced the child did not always want bottles or did not finish the bottles sent in by the parent. Ms. Resendiz stated that she had documentation of conversations with the parent (previously submitted) regarding the child’s feedings. The documentation submitted by Ms. Resendiz noted the following: •On October 18, 2023, at 5:44pm, the parent stated that the parent had been sending in 1-2 pouches or jars of baby food daily since completing the meal plan paperwork, but the baby food is still in the child’s bag each day at pick up. The parent asked that the baby food be given to the child each day along with any mushy table food that could be easily chewed. The director of the facility replied to the message that baby food would be added daily. •On October 27, 2023, at 3:46pm, the parent asked if the child had been fed more than one bottle, which was all that had been logged on the Brightwheel application. The caregiver noted the child had a second bottle and that with the child eating baby food twice a day now, the child did not want as much milk and that three bottles would be sufficient for the time child was in care. •On November 20, 2023, at 4:40pm, the parent asked if the child had been given another bottle since the last feeding logged in the application was at 11:30am. The caregiver replied that the child had eaten baby food and was given a bottle around 2:30pm but the child did not want to take the bottle. •On November 21, 2023, at 1:41pm, the parent asked if the child had another bottle since the once logged in at 9:00am. The caregiver said that the child did have another bottle at lunch before nap, but it had not been logged in. •On December 1, 2023, at 1:34pm, the parent asked if the child had been given any other bottles since 11:00am. The caregiver responded that the child had just finished a bottle and had another bottle that morning after being fed baby food, and that the caregiver was getting ready to log the feeding into the application. •On December 4, 2023, at 6:31pm, the parent stated that the child is being fed baby food right before being given a bottle, and the bottle is supposed to be the child’s main meal and the baby food should be given in between the bottle feeds. The parent stated that the child is being fed a bottle around 11:00am and then fed baby food around 2:00pm when the child should be given another bottle. The parent stated that the child should be given three bottles daily. Ms. Resendiz asked if the parent had completed and returned the feeding plan with a schedule of how the parent wanted the child to be fed. The parent replied that the completed form was given to the director and that the parent was almost “99%” sure that the parent had documented bottles every 3 hours “or so” and baby food be given in between. Ms. Resendiz asked that the parent tell her in this conversation the times she wanted bottle feeding to occur. The parent stated that due to caregivers telling her the child did not want bottles after eating baby food she started sending in smaller jars of baby food. The parent asked that the child be fed a bottle between 8:30am and 9:00am, at 12:00pm, and again around 3:00pm, and that baby food be given between 10:00am and 11:00am and again between 1:00pm and 2:00pm. The parent also stated that the parent could bring in rice cereal and formula for a breakfast snack. Ms. Resendiz responded that she would ensure that the feeding schedule was straightened out. Child Care Rule 10A NCAC 09 .0902(a) states the parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Child Care Rule does not require that each feeding for children be documented and provided to the parent. Operational policies, received by the parent upon enrollment, did not include that a daily report including feedings are provided to parents. However, per rule, any modification to the written plan, such as the introduction of baby food twice daily and the specific times for bottles and baby food to be given, must be posted for reference by caregivers. A written feeding plan for the child was observed to be posted in the infant classroom during the visit. The plan, signed by the parent on July 12, 2023, documented bottle feedings of 4-5 ounces every 3-4 hours. The modifications communicated in the conversation between the parent and Ms. Resendiz on December 4, 2023, were not reflected in the posted feeding plan. The times, types and amounts of food given were not documented daily, therefore the allegation that an infant’s feeding plan was not followed is unsubstantiated, but a violation regarding modifications not being posted will be documented. •It is alleged that staff did not follow medication instructions. Ms. Brown and Ms. Galyean stated that they do remember putting diaper cream on the child named in the complaint and that it was specifically “butt paste”, but they do not remember if the medication authorization was for application after every bowel movement. Authorization and written instructions for diaper cream for this child was not on file and the child is no longer in attendance at the facility. In the documentation received from Ms. Resendiz, a caregiver messaged the parent on August 18, 2023, at 4:32pm, that the child’s bottom was “super red “raw” looking, was bleeding a little when wiped, and it looked like a diaper rash.” The parent replied “Okay [the child] should have diaper cream that should be applied after each bowel movement diaper that [the child] has” and the caregiver replied that the cream would be applied. On September 1, 2023, at 5:11pm, the parent messaged the caregiver and stated that only two diaper changes were logged in the application for the day and that the child should be changed 4-6 times a day based upon diaper changes that occur at home. Child Care Rule does not require retention of medication authorization and instructions after a child is no longer enrolled in care and does not require diapering times to be documented and provided to the parent daily. The facility operational policies, received by the parent upon enrollment, did not include that a daily report would be provided to parents. There is no evidence to support that diaper cream was not applied as instructed on the written authorization form. This allegation is unsubstantiated, and no violations are documented regarding medications. •It is alleged that incident reports are not prepared as required. Ms. Brown stated that an incident report was completed on December 5, 2023, when the child named in the complaint fell forward while sitting up and hit the child’s head on a block. The child had a red mark and scrape on the forehead and Ms. Brown denied that the skin was broken. A copy of the completed incident report, dated December 5, 2023, was received, and reviewed during today’s visit. The report, which was in the infant classroom during today’s visit, documented that the incident occurred at 10:39am. Ms. Brown notified the parent of the incident and sent a photo of the red mark on the child’s head through the messenger application on December 5, 2023, at 10:40am, according to documentation reviewed and received by Ms. Childress. The documentation on the messenger application also noted the parent stating on December 4, 2023, at 6:31pm, that the child was hit by another child with a toy “week before last” and today the parent was “notified” that the child fell and bumped the child’s cheek. The parent stated that the parent was not “notified” until pick up and had not received any accident reports. Ms. Brown and Ms. Galyean denied observing any incident where the child was hit in the head by another child with a toy but did observe the child fall on a block on December 5, 2023, and an incident report completed. Ms. Galyean stated that recently she was sitting on the floor with the children when the child’s grandparent arrived to pick the child up. When the child saw the grandparent, the child fell over onto the rug and a red mark appeared on the child’s cheek. Ms. Galyean did not complete an incident report for a red mark because it was witnessed by the grandparent. According to Ms. Resendiz, the incident report for December 5, 2023, was not provided to the parent, because the grandparent had been picking up the child and they were waiting on the parent to come in to sign the report. The child’s file was reviewed during the visit and a copy of the report was not on file. The incident log was reviewed during the visit and the incident was not entered onto the log. Child Care Rule 10A NCAC 09 .0802(e) & (f) state a copy of the incident report must be given to the parent, or a parent signature obtained declining a copy of the report, the report be maintained in the child’s file, and entered on an incident log. This allegation is substantiated. Based upon the information received it cannot be determined that any other incidents, except on December 5, 2023, occurred which required an incident report. •It is alleged that children are not signed out as required and specifically that a grandparent was not required to sign out a child. Ms. Resendiz stated that the child’s grandparent was authorized to pick the child up from care (noted on the application). The grandparent did not have and could not access the Brightwheel application on the grandparent’s phone to check the child in and out, so they worked with the grandparent, and caregivers and staff signed the child in and out when needed. The facility operational policies, received by the parent upon enrollment, require children to be checked in and out daily using the Brightwheel application or on a daily written check-in/check-out log. Ms. Resendiz stated that the staff were helping the grandparent. The Brightwheel application for the child was reviewed and showed the child’s arrival and departure times documented. Child Care Rule 10A NCAC 09 .0302(d)(4) states daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart, not that the child be signed in and out by a specific person. Based upon the information provided by Ms. Resendiz she feels that her policies were followed in that they were assisting the grandparent with arrival and departure check out. This allegation is unsubstantiated. Information received from Ms. Resendiz on December 18, 19, and 20, 2023 included information that on December 18, 2023, the caregiver, for the child named in the complaint, changed the child’s diaper, and observed blood in the child’s stool. The caregiver, after completing the diaper change messaged and informed the parent of the blood. The parent requested a picture of the bloody stool and Ms. Resendiz, who had also been notified by the caregiver, suggested the staff member not send a picture but keep the diaper enclosed in a bag to provide the parent upon pick up. The other parent called the facility demanding a picture, and the caregiver sent a picture of the diaper and its contents. A woman, who refused to identify herself and told staff that she was not on the pick-up list, arrived at the center, stated she was a nurse and was not waiting and that staff could take it up with the parent who was “already upset” and left with the child. As a result, Ms. Resendiz contacted the Sparta Police Department and reported that there had been an unauthorized pick up of the child and that it was probably a misunderstanding, but the woman refused to give her name or wait until the parent could be contacted and the pickup verified. Ms. Resendiz later learned that the woman was related to the child and was in fact on the pick up list. Ms. Resendiz also messaged the mother that the police had been contacted and that the child’s enrollment was terminated. Documentation provided from the messenger application showed that Ms. Brown sent a message to the mother on December 18, 2023, at 9:43am that the child had a “bunch of blood in [the child’s] bm that the [the child] just had. The parent replied asking if there was a picture, if it was “hard or soft poop,” and stated that the parent needed a picture to send to the doctor to see “what will need to be done.” Ms. Resendiz responded to the parent that they could put the diaper in a bag for the parent to examine. The parent replied that “blood in the stool is a very serious matter and I don’t like at all how this is being handled. A picture could help determine if I’m needing to leave my job and take [the child] to the hospital.” Ms. Resendiz replied that blood in the stool could be serious, and this was why the parent had been contacted. Ms. Resendiz stated that it was up to the parent to make the decision on whether or not the child needed to go to the doctor and asked if there was some scenario when there would be a lot of blood in the child’s stool where the parent would not take the child to the doctor. Documentation on December 19, 2023, included a message from Ms. Resendiz to the parent at 11:58am that due to the incident with the woman arriving at the facility the previous day, a police report was made and that due to a “blatant disrespect” for the center’s policies and “state rules” the child’s enrollment was terminated effective immediately. The parent replied that the woman, the sister of the parent, was on the pickup list, that Ms. Brown was aware of who the sister was and that the parent had spoken to the police who will be filing a report for negligence. Ms. Resendiz stated that she did not receive any paperwork from the officer who came to the facility and did not remember the officer’s name. The investigation will remain open at this time in order to obtain information from law enforcement and collateral contacts. All violations must be corrected immediately, and documentation regarding how the violations were corrected must be emailed to Ms. Childress by January 18, 2024, at tammy.childress@dhhs.nc.gov. During the visit, Ms. Childress’ computer tablet froze and was inoperable, and the regulatory system could not be entered, nor could a visit summary be created as a word document. A copy of the Visit Summary, once created and entered, will be emailed to Ms. Resendiz for her signature. You may contact Ms. Childress with any questions or needed assistance at tammy.childress@dhhs.nc.gov or (336)317-6436. If you have concerns regarding this visit or any violations documented you may contact the Licensing Supervisor, Pamela Hauser at pamela.hauser@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0802 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: 1223-238L Visit Date: 1/4/2024 Number Present: 41 Completed Date: 1/5/2024 Age: From 0 To 12 Total Minutes: 100 Time In: 01:50 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding allegations of violations of child care requirements for program record keeping, medication, and nutrition for infants and toddlers. The visit was conducted with Makayla Edwards, Interim Director, and Heather Resendiz, Owner, by Tammy Burcham, Lead Child Care Consultant. Ms. Edwards accompanied Ms. Childress in a walk-through of the facility and children in care were observed to be engaged in nap time and personal care routines. In addition to alleged violations of child care requirements, staff/child ratios, supervision, adequate/approved space, the license posted, and license restrictions were also monitored. On December 18, 2023, Ms. Resendiz contacted Ms. Childress and provided information regarding some of the allegations. Ms. Resendiz, per the instruction of Ms. Childress, also contacted the intake unit of the Division of Child Development and Early Education, to self-report incidents that had occurred. In addition, Ms. Resendiz submitted documentation of conversations between staff and a parent, a photograph, and other information she felt was pertinent. At that time, all information received did not constitute an investigation. Allegations were discussed with Ms. Edwards, Ms. Resendiz and two additional staff members, Tori Brown, and Jennifer Galyean, during today’s visit. Violation Number Comment Rule 542 The written feeding plan was not modified as the child's needs changed. An infant's feeding plan was not modified on December 4, 2023, to add specific times for bottle feedings and baby food feedings and posted for reference by caregivers. The feeding plan posted in the classroom was signed by the parent and dated July 12, 2023. 10 NCAC 09 .0902(a) 853 Incident logs were not completed and maintained as required. An incident report dated December 5, 2023, was not entered on incident log. .0802(g)(1-6) 1952 A copy of the incident report was not given to the parent. An incident report dated December 5, 2023 was not provided to a parent nor a parent signature declining a copy of the report obtained. .0802(e) The following information was received through staff interviews, documentation, and observations during today’s visit: •It is alleged that an infant’s meal plan was not followed. Ms. Brown and Ms. Galyean stated that the child ate well, and they fed the child as the parent requested. They both gave the child bottles and baby food, but once the baby food was introduced the child did not always want bottles or did not finish the bottles sent in by the parent. Ms. Resendiz stated that she had documentation of conversations with the parent (previously submitted) regarding the child’s feedings. The documentation submitted by Ms. Resendiz noted the following: •On October 18, 2023, at 5:44pm, the parent stated that the parent had been sending in 1-2 pouches or jars of baby food daily since completing the meal plan paperwork, but the baby food is still in the child’s bag each day at pick up. The parent asked that the baby food be given to the child each day along with any mushy table food that could be easily chewed. The director of the facility replied to the message that baby food would be added daily. •On October 27, 2023, at 3:46pm, the parent asked if the child had been fed more than one bottle, which was all that had been logged on the Brightwheel application. The caregiver noted the child had a second bottle and that with the child eating baby food twice a day now, the child did not want as much milk and that three bottles would be sufficient for the time child was in care. •On November 20, 2023, at 4:40pm, the parent asked if the child had been given another bottle since the last feeding logged in the application was at 11:30am. The caregiver replied that the child had eaten baby food and was given a bottle around 2:30pm but the child did not want to take the bottle. •On November 21, 2023, at 1:41pm, the parent asked if the child had another bottle since the once logged in at 9:00am. The caregiver said that the child did have another bottle at lunch before nap, but it had not been logged in. •On December 1, 2023, at 1:34pm, the parent asked if the child had been given any other bottles since 11:00am. The caregiver responded that the child had just finished a bottle and had another bottle that morning after being fed baby food, and that the caregiver was getting ready to log the feeding into the application. •On December 4, 2023, at 6:31pm, the parent stated that the child is being fed baby food right before being given a bottle, and the bottle is supposed to be the child’s main meal and the baby food should be given in between the bottle feeds. The parent stated that the child is being fed a bottle around 11:00am and then fed baby food around 2:00pm when the child should be given another bottle. The parent stated that the child should be given three bottles daily. Ms. Resendiz asked if the parent had completed and returned the feeding plan with a schedule of how the parent wanted the child to be fed. The parent replied that the completed form was given to the director and that the parent was almost “99%” sure that the parent had documented bottles every 3 hours “or so” and baby food be given in between. Ms. Resendiz asked that the parent tell her in this conversation the times she wanted bottle feeding to occur. The parent stated that due to caregivers telling her the child did not want bottles after eating baby food she started sending in smaller jars of baby food. The parent asked that the child be fed a bottle between 8:30am and 9:00am, at 12:00pm, and again around 3:00pm, and that baby food be given between 10:00am and 11:00am and again between 1:00pm and 2:00pm. The parent also stated that the parent could bring in rice cereal and formula for a breakfast snack. Ms. Resendiz responded that she would ensure that the feeding schedule was straightened out. Child Care Rule 10A NCAC 09 .0902(a) states the parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Child Care Rule does not require that each feeding for children be documented and provided to the parent. Operational policies, received by the parent upon enrollment, did not include that a daily report including feedings are provided to parents. However, per rule, any modification to the written plan, such as the introduction of baby food twice daily and the specific times for bottles and baby food to be given, must be posted for reference by caregivers. A written feeding plan for the child was observed to be posted in the infant classroom during the visit. The plan, signed by the parent on July 12, 2023, documented bottle feedings of 4-5 ounces every 3-4 hours. The modifications communicated in the conversation between the parent and Ms. Resendiz on December 4, 2023, were not reflected in the posted feeding plan. The times, types and amounts of food given were not documented daily, therefore the allegation that an infant’s feeding plan was not followed is unsubstantiated, but a violation regarding modifications not being posted will be documented. •It is alleged that staff did not follow medication instructions. Ms. Brown and Ms. Galyean stated that they do remember putting diaper cream on the child named in the complaint and that it was specifically “butt paste”, but they do not remember if the medication authorization was for application after every bowel movement. Authorization and written instructions for diaper cream for this child was not on file and the child is no longer in attendance at the facility. In the documentation received from Ms. Resendiz, a caregiver messaged the parent on August 18, 2023, at 4:32pm, that the child’s bottom was “super red “raw” looking, was bleeding a little when wiped, and it looked like a diaper rash.” The parent replied “Okay [the child] should have diaper cream that should be applied after each bowel movement diaper that [the child] has” and the caregiver replied that the cream would be applied. On September 1, 2023, at 5:11pm, the parent messaged the caregiver and stated that only two diaper changes were logged in the application for the day and that the child should be changed 4-6 times a day based upon diaper changes that occur at home. Child Care Rule does not require retention of medication authorization and instructions after a child is no longer enrolled in care and does not require diapering times to be documented and provided to the parent daily. The facility operational policies, received by the parent upon enrollment, did not include that a daily report would be provided to parents. There is no evidence to support that diaper cream was not applied as instructed on the written authorization form. This allegation is unsubstantiated, and no violations are documented regarding medications. •It is alleged that incident reports are not prepared as required. Ms. Brown stated that an incident report was completed on December 5, 2023, when the child named in the complaint fell forward while sitting up and hit the child’s head on a block. The child had a red mark and scrape on the forehead and Ms. Brown denied that the skin was broken. A copy of the completed incident report, dated December 5, 2023, was received, and reviewed during today’s visit. The report, which was in the infant classroom during today’s visit, documented that the incident occurred at 10:39am. Ms. Brown notified the parent of the incident and sent a photo of the red mark on the child’s head through the messenger application on December 5, 2023, at 10:40am, according to documentation reviewed and received by Ms. Childress. The documentation on the messenger application also noted the parent stating on December 4, 2023, at 6:31pm, that the child was hit by another child with a toy “week before last” and today the parent was “notified” that the child fell and bumped the child’s cheek. The parent stated that the parent was not “notified” until pick up and had not received any accident reports. Ms. Brown and Ms. Galyean denied observing any incident where the child was hit in the head by another child with a toy but did observe the child fall on a block on December 5, 2023, and an incident report completed. Ms. Galyean stated that recently she was sitting on the floor with the children when the child’s grandparent arrived to pick the child up. When the child saw the grandparent, the child fell over onto the rug and a red mark appeared on the child’s cheek. Ms. Galyean did not complete an incident report for a red mark because it was witnessed by the grandparent. According to Ms. Resendiz, the incident report for December 5, 2023, was not provided to the parent, because the grandparent had been picking up the child and they were waiting on the parent to come in to sign the report. The child’s file was reviewed during the visit and a copy of the report was not on file. The incident log was reviewed during the visit and the incident was not entered onto the log. Child Care Rule 10A NCAC 09 .0802(e) & (f) state a copy of the incident report must be given to the parent, or a parent signature obtained declining a copy of the report, the report be maintained in the child’s file, and entered on an incident log. This allegation is substantiated. Based upon the information received it cannot be determined that any other incidents, except on December 5, 2023, occurred which required an incident report. •It is alleged that children are not signed out as required and specifically that a grandparent was not required to sign out a child. Ms. Resendiz stated that the child’s grandparent was authorized to pick the child up from care (noted on the application). The grandparent did not have and could not access the Brightwheel application on the grandparent’s phone to check the child in and out, so they worked with the grandparent, and caregivers and staff signed the child in and out when needed. The facility operational policies, received by the parent upon enrollment, require children to be checked in and out daily using the Brightwheel application or on a daily written check-in/check-out log. Ms. Resendiz stated that the staff were helping the grandparent. The Brightwheel application for the child was reviewed and showed the child’s arrival and departure times documented. Child Care Rule 10A NCAC 09 .0302(d)(4) states daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart, not that the child be signed in and out by a specific person. Based upon the information provided by Ms. Resendiz she feels that her policies were followed in that they were assisting the grandparent with arrival and departure check out. This allegation is unsubstantiated. Information received from Ms. Resendiz on December 18, 19, and 20, 2023 included information that on December 18, 2023, the caregiver, for the child named in the complaint, changed the child’s diaper, and observed blood in the child’s stool. The caregiver, after completing the diaper change messaged and informed the parent of the blood. The parent requested a picture of the bloody stool and Ms. Resendiz, who had also been notified by the caregiver, suggested the staff member not send a picture but keep the diaper enclosed in a bag to provide the parent upon pick up. The other parent called the facility demanding a picture, and the caregiver sent a picture of the diaper and its contents. A woman, who refused to identify herself and told staff that she was not on the pick-up list, arrived at the center, stated she was a nurse and was not waiting and that staff could take it up with the parent who was “already upset” and left with the child. As a result, Ms. Resendiz contacted the Sparta Police Department and reported that there had been an unauthorized pick up of the child and that it was probably a misunderstanding, but the woman refused to give her name or wait until the parent could be contacted and the pickup verified. Ms. Resendiz later learned that the woman was related to the child and was in fact on the pick up list. Ms. Resendiz also messaged the mother that the police had been contacted and that the child’s enrollment was terminated. Documentation provided from the messenger application showed that Ms. Brown sent a message to the mother on December 18, 2023, at 9:43am that the child had a “bunch of blood in [the child’s] bm that the [the child] just had. The parent replied asking if there was a picture, if it was “hard or soft poop,” and stated that the parent needed a picture to send to the doctor to see “what will need to be done.” Ms. Resendiz responded to the parent that they could put the diaper in a bag for the parent to examine. The parent replied that “blood in the stool is a very serious matter and I don’t like at all how this is being handled. A picture could help determine if I’m needing to leave my job and take [the child] to the hospital.” Ms. Resendiz replied that blood in the stool could be serious, and this was why the parent had been contacted. Ms. Resendiz stated that it was up to the parent to make the decision on whether or not the child needed to go to the doctor and asked if there was some scenario when there would be a lot of blood in the child’s stool where the parent would not take the child to the doctor. Documentation on December 19, 2023, included a message from Ms. Resendiz to the parent at 11:58am that due to the incident with the woman arriving at the facility the previous day, a police report was made and that due to a “blatant disrespect” for the center’s policies and “state rules” the child’s enrollment was terminated effective immediately. The parent replied that the woman, the sister of the parent, was on the pickup list, that Ms. Brown was aware of who the sister was and that the parent had spoken to the police who will be filing a report for negligence. Ms. Resendiz stated that she did not receive any paperwork from the officer who came to the facility and did not remember the officer’s name. The investigation will remain open at this time in order to obtain information from law enforcement and collateral contacts. All violations must be corrected immediately, and documentation regarding how the violations were corrected must be emailed to Ms. Childress by January 18, 2024, at tammy.childress@dhhs.nc.gov. During the visit, Ms. Childress’ computer tablet froze and was inoperable, and the regulatory system could not be entered, nor could a visit summary be created as a word document. A copy of the Visit Summary, once created and entered, will be emailed to Ms. Resendiz for her signature. You may contact Ms. Childress with any questions or needed assistance at tammy.childress@dhhs.nc.gov or (336)317-6436. If you have concerns regarding this visit or any violations documented you may contact the Licensing Supervisor, Pamela Hauser at pamela.hauser@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: 1223-238L Visit Date: 1/4/2024 Number Present: 41 Completed Date: 1/5/2024 Age: From 0 To 12 Total Minutes: 100 Time In: 01:50 PM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to obtain information regarding allegations of violations of child care requirements for program record keeping, medication, and nutrition for infants and toddlers. The visit was conducted with Makayla Edwards, Interim Director, and Heather Resendiz, Owner, by Tammy Burcham, Lead Child Care Consultant. Ms. Edwards accompanied Ms. Childress in a walk-through of the facility and children in care were observed to be engaged in nap time and personal care routines. In addition to alleged violations of child care requirements, staff/child ratios, supervision, adequate/approved space, the license posted, and license restrictions were also monitored. On December 18, 2023, Ms. Resendiz contacted Ms. Childress and provided information regarding some of the allegations. Ms. Resendiz, per the instruction of Ms. Childress, also contacted the intake unit of the Division of Child Development and Early Education, to self-report incidents that had occurred. In addition, Ms. Resendiz submitted documentation of conversations between staff and a parent, a photograph, and other information she felt was pertinent. At that time, all information received did not constitute an investigation. Allegations were discussed with Ms. Edwards, Ms. Resendiz and two additional staff members, Tori Brown, and Jennifer Galyean, during today’s visit. Violation Number Comment Rule 542 The written feeding plan was not modified as the child's needs changed. An infant's feeding plan was not modified on December 4, 2023, to add specific times for bottle feedings and baby food feedings and posted for reference by caregivers. The feeding plan posted in the classroom was signed by the parent and dated July 12, 2023. 10 NCAC 09 .0902(a) 853 Incident logs were not completed and maintained as required. An incident report dated December 5, 2023, was not entered on incident log. .0802(g)(1-6) 1952 A copy of the incident report was not given to the parent. An incident report dated December 5, 2023 was not provided to a parent nor a parent signature declining a copy of the report obtained. .0802(e) The following information was received through staff interviews, documentation, and observations during today’s visit: •It is alleged that an infant’s meal plan was not followed. Ms. Brown and Ms. Galyean stated that the child ate well, and they fed the child as the parent requested. They both gave the child bottles and baby food, but once the baby food was introduced the child did not always want bottles or did not finish the bottles sent in by the parent. Ms. Resendiz stated that she had documentation of conversations with the parent (previously submitted) regarding the child’s feedings. The documentation submitted by Ms. Resendiz noted the following: •On October 18, 2023, at 5:44pm, the parent stated that the parent had been sending in 1-2 pouches or jars of baby food daily since completing the meal plan paperwork, but the baby food is still in the child’s bag each day at pick up. The parent asked that the baby food be given to the child each day along with any mushy table food that could be easily chewed. The director of the facility replied to the message that baby food would be added daily. •On October 27, 2023, at 3:46pm, the parent asked if the child had been fed more than one bottle, which was all that had been logged on the Brightwheel application. The caregiver noted the child had a second bottle and that with the child eating baby food twice a day now, the child did not want as much milk and that three bottles would be sufficient for the time child was in care. •On November 20, 2023, at 4:40pm, the parent asked if the child had been given another bottle since the last feeding logged in the application was at 11:30am. The caregiver replied that the child had eaten baby food and was given a bottle around 2:30pm but the child did not want to take the bottle. •On November 21, 2023, at 1:41pm, the parent asked if the child had another bottle since the once logged in at 9:00am. The caregiver said that the child did have another bottle at lunch before nap, but it had not been logged in. •On December 1, 2023, at 1:34pm, the parent asked if the child had been given any other bottles since 11:00am. The caregiver responded that the child had just finished a bottle and had another bottle that morning after being fed baby food, and that the caregiver was getting ready to log the feeding into the application. •On December 4, 2023, at 6:31pm, the parent stated that the child is being fed baby food right before being given a bottle, and the bottle is supposed to be the child’s main meal and the baby food should be given in between the bottle feeds. The parent stated that the child is being fed a bottle around 11:00am and then fed baby food around 2:00pm when the child should be given another bottle. The parent stated that the child should be given three bottles daily. Ms. Resendiz asked if the parent had completed and returned the feeding plan with a schedule of how the parent wanted the child to be fed. The parent replied that the completed form was given to the director and that the parent was almost “99%” sure that the parent had documented bottles every 3 hours “or so” and baby food be given in between. Ms. Resendiz asked that the parent tell her in this conversation the times she wanted bottle feeding to occur. The parent stated that due to caregivers telling her the child did not want bottles after eating baby food she started sending in smaller jars of baby food. The parent asked that the child be fed a bottle between 8:30am and 9:00am, at 12:00pm, and again around 3:00pm, and that baby food be given between 10:00am and 11:00am and again between 1:00pm and 2:00pm. The parent also stated that the parent could bring in rice cereal and formula for a breakfast snack. Ms. Resendiz responded that she would ensure that the feeding schedule was straightened out. Child Care Rule 10A NCAC 09 .0902(a) states the parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Child Care Rule does not require that each feeding for children be documented and provided to the parent. Operational policies, received by the parent upon enrollment, did not include that a daily report including feedings are provided to parents. However, per rule, any modification to the written plan, such as the introduction of baby food twice daily and the specific times for bottles and baby food to be given, must be posted for reference by caregivers. A written feeding plan for the child was observed to be posted in the infant classroom during the visit. The plan, signed by the parent on July 12, 2023, documented bottle feedings of 4-5 ounces every 3-4 hours. The modifications communicated in the conversation between the parent and Ms. Resendiz on December 4, 2023, were not reflected in the posted feeding plan. The times, types and amounts of food given were not documented daily, therefore the allegation that an infant’s feeding plan was not followed is unsubstantiated, but a violation regarding modifications not being posted will be documented. •It is alleged that staff did not follow medication instructions. Ms. Brown and Ms. Galyean stated that they do remember putting diaper cream on the child named in the complaint and that it was specifically “butt paste”, but they do not remember if the medication authorization was for application after every bowel movement. Authorization and written instructions for diaper cream for this child was not on file and the child is no longer in attendance at the facility. In the documentation received from Ms. Resendiz, a caregiver messaged the parent on August 18, 2023, at 4:32pm, that the child’s bottom was “super red “raw” looking, was bleeding a little when wiped, and it looked like a diaper rash.” The parent replied “Okay [the child] should have diaper cream that should be applied after each bowel movement diaper that [the child] has” and the caregiver replied that the cream would be applied. On September 1, 2023, at 5:11pm, the parent messaged the caregiver and stated that only two diaper changes were logged in the application for the day and that the child should be changed 4-6 times a day based upon diaper changes that occur at home. Child Care Rule does not require retention of medication authorization and instructions after a child is no longer enrolled in care and does not require diapering times to be documented and provided to the parent daily. The facility operational policies, received by the parent upon enrollment, did not include that a daily report would be provided to parents. There is no evidence to support that diaper cream was not applied as instructed on the written authorization form. This allegation is unsubstantiated, and no violations are documented regarding medications. •It is alleged that incident reports are not prepared as required. Ms. Brown stated that an incident report was completed on December 5, 2023, when the child named in the complaint fell forward while sitting up and hit the child’s head on a block. The child had a red mark and scrape on the forehead and Ms. Brown denied that the skin was broken. A copy of the completed incident report, dated December 5, 2023, was received, and reviewed during today’s visit. The report, which was in the infant classroom during today’s visit, documented that the incident occurred at 10:39am. Ms. Brown notified the parent of the incident and sent a photo of the red mark on the child’s head through the messenger application on December 5, 2023, at 10:40am, according to documentation reviewed and received by Ms. Childress. The documentation on the messenger application also noted the parent stating on December 4, 2023, at 6:31pm, that the child was hit by another child with a toy “week before last” and today the parent was “notified” that the child fell and bumped the child’s cheek. The parent stated that the parent was not “notified” until pick up and had not received any accident reports. Ms. Brown and Ms. Galyean denied observing any incident where the child was hit in the head by another child with a toy but did observe the child fall on a block on December 5, 2023, and an incident report completed. Ms. Galyean stated that recently she was sitting on the floor with the children when the child’s grandparent arrived to pick the child up. When the child saw the grandparent, the child fell over onto the rug and a red mark appeared on the child’s cheek. Ms. Galyean did not complete an incident report for a red mark because it was witnessed by the grandparent. According to Ms. Resendiz, the incident report for December 5, 2023, was not provided to the parent, because the grandparent had been picking up the child and they were waiting on the parent to come in to sign the report. The child’s file was reviewed during the visit and a copy of the report was not on file. The incident log was reviewed during the visit and the incident was not entered onto the log. Child Care Rule 10A NCAC 09 .0802(e) & (f) state a copy of the incident report must be given to the parent, or a parent signature obtained declining a copy of the report, the report be maintained in the child’s file, and entered on an incident log. This allegation is substantiated. Based upon the information received it cannot be determined that any other incidents, except on December 5, 2023, occurred which required an incident report. •It is alleged that children are not signed out as required and specifically that a grandparent was not required to sign out a child. Ms. Resendiz stated that the child’s grandparent was authorized to pick the child up from care (noted on the application). The grandparent did not have and could not access the Brightwheel application on the grandparent’s phone to check the child in and out, so they worked with the grandparent, and caregivers and staff signed the child in and out when needed. The facility operational policies, received by the parent upon enrollment, require children to be checked in and out daily using the Brightwheel application or on a daily written check-in/check-out log. Ms. Resendiz stated that the staff were helping the grandparent. The Brightwheel application for the child was reviewed and showed the child’s arrival and departure times documented. Child Care Rule 10A NCAC 09 .0302(d)(4) states daily records of arrival and departure times at the center for each child which shall be maintained as children arrive and depart, not that the child be signed in and out by a specific person. Based upon the information provided by Ms. Resendiz she feels that her policies were followed in that they were assisting the grandparent with arrival and departure check out. This allegation is unsubstantiated. Information received from Ms. Resendiz on December 18, 19, and 20, 2023 included information that on December 18, 2023, the caregiver, for the child named in the complaint, changed the child’s diaper, and observed blood in the child’s stool. The caregiver, after completing the diaper change messaged and informed the parent of the blood. The parent requested a picture of the bloody stool and Ms. Resendiz, who had also been notified by the caregiver, suggested the staff member not send a picture but keep the diaper enclosed in a bag to provide the parent upon pick up. The other parent called the facility demanding a picture, and the caregiver sent a picture of the diaper and its contents. A woman, who refused to identify herself and told staff that she was not on the pick-up list, arrived at the center, stated she was a nurse and was not waiting and that staff could take it up with the parent who was “already upset” and left with the child. As a result, Ms. Resendiz contacted the Sparta Police Department and reported that there had been an unauthorized pick up of the child and that it was probably a misunderstanding, but the woman refused to give her name or wait until the parent could be contacted and the pickup verified. Ms. Resendiz later learned that the woman was related to the child and was in fact on the pick up list. Ms. Resendiz also messaged the mother that the police had been contacted and that the child’s enrollment was terminated. Documentation provided from the messenger application showed that Ms. Brown sent a message to the mother on December 18, 2023, at 9:43am that the child had a “bunch of blood in [the child’s] bm that the [the child] just had. The parent replied asking if there was a picture, if it was “hard or soft poop,” and stated that the parent needed a picture to send to the doctor to see “what will need to be done.” Ms. Resendiz responded to the parent that they could put the diaper in a bag for the parent to examine. The parent replied that “blood in the stool is a very serious matter and I don’t like at all how this is being handled. A picture could help determine if I’m needing to leave my job and take [the child] to the hospital.” Ms. Resendiz replied that blood in the stool could be serious, and this was why the parent had been contacted. Ms. Resendiz stated that it was up to the parent to make the decision on whether or not the child needed to go to the doctor and asked if there was some scenario when there would be a lot of blood in the child’s stool where the parent would not take the child to the doctor. Documentation on December 19, 2023, included a message from Ms. Resendiz to the parent at 11:58am that due to the incident with the woman arriving at the facility the previous day, a police report was made and that due to a “blatant disrespect” for the center’s policies and “state rules” the child’s enrollment was terminated effective immediately. The parent replied that the woman, the sister of the parent, was on the pickup list, that Ms. Brown was aware of who the sister was and that the parent had spoken to the police who will be filing a report for negligence. Ms. Resendiz stated that she did not receive any paperwork from the officer who came to the facility and did not remember the officer’s name. The investigation will remain open at this time in order to obtain information from law enforcement and collateral contacts. All violations must be corrected immediately, and documentation regarding how the violations were corrected must be emailed to Ms. Childress by January 18, 2024, at tammy.childress@dhhs.nc.gov. During the visit, Ms. Childress’ computer tablet froze and was inoperable, and the regulatory system could not be entered, nor could a visit summary be created as a word document. A copy of the Visit Summary, once created and entered, will be emailed to Ms. Resendiz for her signature. You may contact Ms. Childress with any questions or needed assistance at tammy.childress@dhhs.nc.gov or (336)317-6436. If you have concerns regarding this visit or any violations documented you may contact the Licensing Supervisor, Pamela Hauser at pamela.hauser@dhhs.nc.gov. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/26/2023 Number Present: 25 Completed Date: 10/27/2023 Age: From 0 To 4 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, with restrictions of daytime care only and children under 2 ½ years old in rooms with direct exits only. The building has four classrooms and one additional classroom in a second building. Heather Resendiz is the sole proprietor of the business. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals and snacks are prepared at the facility and children eat in classrooms. There are three playgrounds separated for infants/toddlers, preschoolers, and school age children. During today’s visit children present were observed to be engaged in outdoor play, indoor free choice activities, personal care routines, lunch, and rest time. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. In Space 5, a current activity plan was not posted for the school age children. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets not in use in Space 1 near an infant crib and Space 4 in a children's activity center were not covered with safety plug covers. 10A NCAC 09 .0604(c) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor in Space 1. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. In Space 1, two medication authorization forms for 2 different medications (Colic Calm and Gripe Water) for an enrolled infant were on file, but the actual medication on-site (Infant's Mylicon Gas Relief) was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the recommended manufacturers dosage listed on the bottle that was on-site by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Staff have not administered the medication on-site. 10A NCAC 09 .0803(4)(6-9) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. In Space 1, a six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. .0606(g) 9995 A violation was found for which there is no item number. In Space 4, a staff member's purse was observed on a shelf lower than five feet from the floor, a violation of Sanitation Rule 15A NCAC 18A .2820(g) Purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. 9996 A violation was found for which there is no item number. In Space 3, a training/sippy cup filled with milk was observed on top of the diaper changing table, a violation of Sanitation Rule 15A NCAC 18A .2819(b) Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good repair. Nothing shall be placed on the diapering surface except for those items required for diapering and the child whose diaper will be changed. If diapering is performed on the floor in a toilet room, then a smooth, intact, nonabsorbent barrier that is clean and in good repair shall be placed on the floor to minimize cross-contamination. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 9, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov, and include the name and ID# for the facility, date of the visit, date of the letter, each item# for each violation and a date each violation was corrected and how it was corrected, and sign the documentation. Each violation must be fully corrected. Documentation of compliance must note state that a violation will be corrected once other actions are taken. If you cannot correct the violation by November 9, 2023, please email Ms. Childress immediately, with the Item# of the violation, and explanation as to why it cannot be corrected, and you may request for additional time to be considered to allow you to correct the violation. You must be specific about the amount of time you would need and a date you feel the violation(s) will be corrected. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment were emailed to Ms. McCoy and Ms. Resendiz on August 21, 2023, and the forms were to be returned to me by October 16, 2023. The applications have not been received. Ms. McCoy stated that they wished to complete the Environment Rating Scale Assessment but were going to rearrange classrooms. We discussed the importance of seeking technical assistance to assist staff in preparing and that the applications forms must be submitted to request the assessments. The assessments must be completed in time for Ms. Childress to process the star rated license prior to the expiration of the temporary license. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Alleghany County Partnership for Children 61 Wee Care Avenue Sparta, NC 28675 336-372-2846 Website: alleghanychildren.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: During today’s visit, I reviewed with Ms. McCoy the DCDEE website and where to locate and how to use the item number listing along with Chapter 9 Child Care Rules. In the items listing you will see the child care rule, general statute and/or the sanitation rule which is applicable to each item. Violations documented today are regarding activity plans, medications, safe sleep policy and sanitation. It is recommended that the violations, applicable child care, general statute or sanitation rule be reviewed with all staff members as part of correcting the violations. Please reach out to Ms. Childress or the Alleghany Partnership for Children if you need assistance with consultation or training related to these rules. Daily Schedules and Activity Plans Item # 428- A current activity plan was not posted for the school age children. Requirements for activity plans intended to stimulate emotional and social development, health and physical development, approaches to play and learning, language development and communication, and cognitive development are important for all age groups of children, including school age children who may only be present for a short amount of time during the school year. Planned experiences that meet the developmental domains listed are important for school age children. Safety and Health Item # 812- When electrical outlets are not in use, and are accessible to children, they must be covered with safety plugs. During today’s visit one electrical outlet on the wall at the top of a child’s crib was not covered. We discussed that once a child could pull up and stand, the crib did not need to be placed near electrical outlets at all. Another uncovered outlet was observed in an activity center in the preschool classroom. All staff must re-cover outlets with safety plug covers after using them. Storage of Hazardous Items and Medication Item # 841- A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor. We discussed that Benadryl was not considered an emergency medication and must be in locked storage. Staff should look closely at all medications brought in by parents and store the medications as required. Sanitation Rule 15A NCAC 18A .2801(11) defines an emergency medication as medication needed to immediately treat a life-threatening medical event that is administered in accordance with 10A NCAC 09 .0803(10) and G.S. 110-102.1A. Item # 847- Parent’s medication authorization must include all required information. A parent had completed 2 medication authorization forms for 2 different medications (gas drops) for an enrolled infant, but the actual medication (gas drops) on-site was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the dosage listed on the bottle on-site and recommended by the manufacturer by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Again, staff must closely monitor the medication and authorization forms for any medication brought in to the center by parents. Safe Sleep Policies and Practices Item # 887- Visual checks for two sleeping infants were not conducted as required today. A six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. The purpose of visually checking infants while sleeping is to help reduce the risk of Sudden Infant Death Syndrome (SIDS) which is a leading cause of death among infants aged 12 months and younger. The facility safe sleep policy indicates that staff will visually check sleeping infants every 15 minutes and record the observations. Staff are currently supposed to use an application on their cell phones to record the safe sleep checks for each sleep infant. As evidenced by observations and in speaking with staff, they are not forgetting to enter the information on the app but rather they are not completing the visual checks at all. It is recommended that you immediately implement the use of a hardcopy Safe Sleep Chart form to be completed by staff as opposed to or in addition to opening the application and entering it in on their cell phones. An Infant Sleep Chart form is available on the DCDEE website at https://nchildcare.ncdhhs.gov under Provider Documents and Forms. Sanitation Rule 15A NCAC 18A .2820(b) & (g) Storage Purses and other personal belongings for all staff members must be placed where they are inaccessible to children. “Inaccessible” is defined as when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor regardless of the age of children in care. Sanitation Rule 15A NCAC 18A .2819(b) Diapering and Diaper Changing Facilities A training cup with a lid and spout filled with milk was observed on top of the diaper changing table. The cup was not labeled and the children and staff in the classroom were outside on the playground. Only the child who is receiving a diaper change and the items required for diaper changing can be on the diapering surface. When children are served meals and beverages, including milk, and the children finish eating, all cups and utensils must be immediately discarded or returned to the kitchen for cleaning and sanitizing. Cups of milk should not remain in the classroom after the completion of the meal with which it was served. Classroom Arrangement Relating to Supervision and Infant Safe Sleep During today’s visit, a staff member in the infant’s classroom was observed sitting in the floor with four infants and was engaged in play and conversation and one infant was asleep in a crib. The area where the staff member was sitting and the area where the infant was sleeping was separated by three low shelves and a long gate. The arrangement of the shelving prevented the staff member from being able to see the sleeping infant unless the staff member put effort into standing up or stretching up to see the infant. The gate was being used to prevent more mobile children from accessing the area where the infant was sleeping. The diapering area, sinks and food prep area with the refrigerator containing bottles was located on the side of the room where the infant was sleeping and is opposite of where the caregiver was sitting with the children who were awake. This may be a contributing factor as to why safe sleep checks are not being conducted. The placement of the shelving and gate separated the classrooms into two defined independent spaces. During pre-licensing the owner wanted the space to be divided into two classrooms. However, approval has not been received from sanitation. Ms. McCoy stated that she had considered rearranging the room with cribs all placed together on the right side of the room and moving the shelving. Based on observations today, in order for one caregiver to be able to provide personal care routines at different times, be able to conduct safe sleep checks, and supervise children appropriately, the caregiver would have to constantly move the entire group of infants from one area to another. Providing care is being compromised by the current arrangement of the shelves and gate. To immediately address the potential risk of the health and safety of children, Ms. Childress and Ms. McCoy discussed moving the shelves and the gate to open the classroom up and allow for movement and clear supervision. Ms. Childress assisted Ms. McCoy in rearranging the room. Ms. McCoy stated that she may continue to make changes to the space to allow staff to be able to supervise and care for children. Documentation regarding the final plans for room arrangement of this classroom must be submitted to Ms. Childress by November 9, 2023. Rated License Application and Request for Environment Rating Scale Assessments Rated License Application and request for the Environment Rating Scale Assessments Rated License Application and Request for Environment Rating Scale Assessments must be submitted to Ms. Childress no later than November 1, 2023. Building and Fire Inspections A building and fire inspection must be completed and submitted to Ms. Childress prior to the expiration of the temporary license. Failure to submit approved inspections will result in an administrative action not limited to a denial of a license to operate. Consultation: Health and Safety Training All staff must complete Health and Safety Trainings within one year of hire and must be repeated every five years with training certificates on file for review. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. This training is not counted as part of staff orientation. Orientation For New Staff/ New Staff Files/ CPR/FA and Trainings Health and safety training shall be in addition to the new staff orientation requirements. Orientation topics should be a review of the policies specific to your facility. All staff, including the director, must receive 16 hours of orientation. The orientation form is available on the DCDEE website www.ncchildcare.ncdhhs.gov under provider documents and forms. All new staff must complete CPR/FA training within 90 days of hire and the trainer must be an approved trainer. A list of approved instructors and agencies can be found at https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/cpr_first_aid_information_Revised_2022%20(1).pdf?ver=8LaabqtKa9JzfMR_Be60qA%3d%3d. Online only CPR/FA courses will not be accepted. The director and any child care provider in the infant classroom must complete ITS-SIDS training. Director(s) must complete the training within 90 days of hire and every three years thereafter. Staff working with infants must complete the training within 2 months of assuming caregiving responsibilities in the infant classroom and every three years thereafter. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff who are responsible for supervising groups of school-age children (group leaders) shall be at least 18 years of age and have a high school diploma or its equivalent prior to employment and shall complete the BSAC (Basic School Age Care) training. Staff who assist group leaders (assistant group leaders) shall be at least 16 years of age and shall complete the BSAC training. When an individual has responsibility for both administering the program and planning and ensuring the implementation of the daily activities of a school-age program (Program Coordinator), the individual shall meet the staff requirements for an administrator and shall complete the BSAC training. This training can be accessed at https://www.swcdcinc.org/basic-school-age-care-bsac-resources or you can contact your local child care and resource referral agency for scheduling if available. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. WORKS Accounts and Staff Education All staff members must have a WORKS Account and the accounts must updated with the correct education information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. If you have any questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding any violations documented during today's visit. 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: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/26/2023 Number Present: 25 Completed Date: 10/27/2023 Age: From 0 To 4 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, with restrictions of daytime care only and children under 2 ½ years old in rooms with direct exits only. The building has four classrooms and one additional classroom in a second building. Heather Resendiz is the sole proprietor of the business. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals and snacks are prepared at the facility and children eat in classrooms. There are three playgrounds separated for infants/toddlers, preschoolers, and school age children. During today’s visit children present were observed to be engaged in outdoor play, indoor free choice activities, personal care routines, lunch, and rest time. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. In Space 5, a current activity plan was not posted for the school age children. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets not in use in Space 1 near an infant crib and Space 4 in a children's activity center were not covered with safety plug covers. 10A NCAC 09 .0604(c) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor in Space 1. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. In Space 1, two medication authorization forms for 2 different medications (Colic Calm and Gripe Water) for an enrolled infant were on file, but the actual medication on-site (Infant's Mylicon Gas Relief) was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the recommended manufacturers dosage listed on the bottle that was on-site by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Staff have not administered the medication on-site. 10A NCAC 09 .0803(4)(6-9) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. In Space 1, a six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. .0606(g) 9995 A violation was found for which there is no item number. In Space 4, a staff member's purse was observed on a shelf lower than five feet from the floor, a violation of Sanitation Rule 15A NCAC 18A .2820(g) Purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. 9996 A violation was found for which there is no item number. In Space 3, a training/sippy cup filled with milk was observed on top of the diaper changing table, a violation of Sanitation Rule 15A NCAC 18A .2819(b) Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good repair. Nothing shall be placed on the diapering surface except for those items required for diapering and the child whose diaper will be changed. If diapering is performed on the floor in a toilet room, then a smooth, intact, nonabsorbent barrier that is clean and in good repair shall be placed on the floor to minimize cross-contamination. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 9, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov, and include the name and ID# for the facility, date of the visit, date of the letter, each item# for each violation and a date each violation was corrected and how it was corrected, and sign the documentation. Each violation must be fully corrected. Documentation of compliance must note state that a violation will be corrected once other actions are taken. If you cannot correct the violation by November 9, 2023, please email Ms. Childress immediately, with the Item# of the violation, and explanation as to why it cannot be corrected, and you may request for additional time to be considered to allow you to correct the violation. You must be specific about the amount of time you would need and a date you feel the violation(s) will be corrected. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment were emailed to Ms. McCoy and Ms. Resendiz on August 21, 2023, and the forms were to be returned to me by October 16, 2023. The applications have not been received. Ms. McCoy stated that they wished to complete the Environment Rating Scale Assessment but were going to rearrange classrooms. We discussed the importance of seeking technical assistance to assist staff in preparing and that the applications forms must be submitted to request the assessments. The assessments must be completed in time for Ms. Childress to process the star rated license prior to the expiration of the temporary license. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Alleghany County Partnership for Children 61 Wee Care Avenue Sparta, NC 28675 336-372-2846 Website: alleghanychildren.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: During today’s visit, I reviewed with Ms. McCoy the DCDEE website and where to locate and how to use the item number listing along with Chapter 9 Child Care Rules. In the items listing you will see the child care rule, general statute and/or the sanitation rule which is applicable to each item. Violations documented today are regarding activity plans, medications, safe sleep policy and sanitation. It is recommended that the violations, applicable child care, general statute or sanitation rule be reviewed with all staff members as part of correcting the violations. Please reach out to Ms. Childress or the Alleghany Partnership for Children if you need assistance with consultation or training related to these rules. Daily Schedules and Activity Plans Item # 428- A current activity plan was not posted for the school age children. Requirements for activity plans intended to stimulate emotional and social development, health and physical development, approaches to play and learning, language development and communication, and cognitive development are important for all age groups of children, including school age children who may only be present for a short amount of time during the school year. Planned experiences that meet the developmental domains listed are important for school age children. Safety and Health Item # 812- When electrical outlets are not in use, and are accessible to children, they must be covered with safety plugs. During today’s visit one electrical outlet on the wall at the top of a child’s crib was not covered. We discussed that once a child could pull up and stand, the crib did not need to be placed near electrical outlets at all. Another uncovered outlet was observed in an activity center in the preschool classroom. All staff must re-cover outlets with safety plug covers after using them. Storage of Hazardous Items and Medication Item # 841- A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor. We discussed that Benadryl was not considered an emergency medication and must be in locked storage. Staff should look closely at all medications brought in by parents and store the medications as required. Sanitation Rule 15A NCAC 18A .2801(11) defines an emergency medication as medication needed to immediately treat a life-threatening medical event that is administered in accordance with 10A NCAC 09 .0803(10) and G.S. 110-102.1A. Item # 847- Parent’s medication authorization must include all required information. A parent had completed 2 medication authorization forms for 2 different medications (gas drops) for an enrolled infant, but the actual medication (gas drops) on-site was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the dosage listed on the bottle on-site and recommended by the manufacturer by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Again, staff must closely monitor the medication and authorization forms for any medication brought in to the center by parents. Safe Sleep Policies and Practices Item # 887- Visual checks for two sleeping infants were not conducted as required today. A six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. The purpose of visually checking infants while sleeping is to help reduce the risk of Sudden Infant Death Syndrome (SIDS) which is a leading cause of death among infants aged 12 months and younger. The facility safe sleep policy indicates that staff will visually check sleeping infants every 15 minutes and record the observations. Staff are currently supposed to use an application on their cell phones to record the safe sleep checks for each sleep infant. As evidenced by observations and in speaking with staff, they are not forgetting to enter the information on the app but rather they are not completing the visual checks at all. It is recommended that you immediately implement the use of a hardcopy Safe Sleep Chart form to be completed by staff as opposed to or in addition to opening the application and entering it in on their cell phones. An Infant Sleep Chart form is available on the DCDEE website at https://nchildcare.ncdhhs.gov under Provider Documents and Forms. Sanitation Rule 15A NCAC 18A .2820(b) & (g) Storage Purses and other personal belongings for all staff members must be placed where they are inaccessible to children. “Inaccessible” is defined as when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor regardless of the age of children in care. Sanitation Rule 15A NCAC 18A .2819(b) Diapering and Diaper Changing Facilities A training cup with a lid and spout filled with milk was observed on top of the diaper changing table. The cup was not labeled and the children and staff in the classroom were outside on the playground. Only the child who is receiving a diaper change and the items required for diaper changing can be on the diapering surface. When children are served meals and beverages, including milk, and the children finish eating, all cups and utensils must be immediately discarded or returned to the kitchen for cleaning and sanitizing. Cups of milk should not remain in the classroom after the completion of the meal with which it was served. Classroom Arrangement Relating to Supervision and Infant Safe Sleep During today’s visit, a staff member in the infant’s classroom was observed sitting in the floor with four infants and was engaged in play and conversation and one infant was asleep in a crib. The area where the staff member was sitting and the area where the infant was sleeping was separated by three low shelves and a long gate. The arrangement of the shelving prevented the staff member from being able to see the sleeping infant unless the staff member put effort into standing up or stretching up to see the infant. The gate was being used to prevent more mobile children from accessing the area where the infant was sleeping. The diapering area, sinks and food prep area with the refrigerator containing bottles was located on the side of the room where the infant was sleeping and is opposite of where the caregiver was sitting with the children who were awake. This may be a contributing factor as to why safe sleep checks are not being conducted. The placement of the shelving and gate separated the classrooms into two defined independent spaces. During pre-licensing the owner wanted the space to be divided into two classrooms. However, approval has not been received from sanitation. Ms. McCoy stated that she had considered rearranging the room with cribs all placed together on the right side of the room and moving the shelving. Based on observations today, in order for one caregiver to be able to provide personal care routines at different times, be able to conduct safe sleep checks, and supervise children appropriately, the caregiver would have to constantly move the entire group of infants from one area to another. Providing care is being compromised by the current arrangement of the shelves and gate. To immediately address the potential risk of the health and safety of children, Ms. Childress and Ms. McCoy discussed moving the shelves and the gate to open the classroom up and allow for movement and clear supervision. Ms. Childress assisted Ms. McCoy in rearranging the room. Ms. McCoy stated that she may continue to make changes to the space to allow staff to be able to supervise and care for children. Documentation regarding the final plans for room arrangement of this classroom must be submitted to Ms. Childress by November 9, 2023. Rated License Application and Request for Environment Rating Scale Assessments Rated License Application and request for the Environment Rating Scale Assessments Rated License Application and Request for Environment Rating Scale Assessments must be submitted to Ms. Childress no later than November 1, 2023. Building and Fire Inspections A building and fire inspection must be completed and submitted to Ms. Childress prior to the expiration of the temporary license. Failure to submit approved inspections will result in an administrative action not limited to a denial of a license to operate. Consultation: Health and Safety Training All staff must complete Health and Safety Trainings within one year of hire and must be repeated every five years with training certificates on file for review. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. This training is not counted as part of staff orientation. Orientation For New Staff/ New Staff Files/ CPR/FA and Trainings Health and safety training shall be in addition to the new staff orientation requirements. Orientation topics should be a review of the policies specific to your facility. All staff, including the director, must receive 16 hours of orientation. The orientation form is available on the DCDEE website www.ncchildcare.ncdhhs.gov under provider documents and forms. All new staff must complete CPR/FA training within 90 days of hire and the trainer must be an approved trainer. A list of approved instructors and agencies can be found at https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/cpr_first_aid_information_Revised_2022%20(1).pdf?ver=8LaabqtKa9JzfMR_Be60qA%3d%3d. Online only CPR/FA courses will not be accepted. The director and any child care provider in the infant classroom must complete ITS-SIDS training. Director(s) must complete the training within 90 days of hire and every three years thereafter. Staff working with infants must complete the training within 2 months of assuming caregiving responsibilities in the infant classroom and every three years thereafter. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff who are responsible for supervising groups of school-age children (group leaders) shall be at least 18 years of age and have a high school diploma or its equivalent prior to employment and shall complete the BSAC (Basic School Age Care) training. Staff who assist group leaders (assistant group leaders) shall be at least 16 years of age and shall complete the BSAC training. When an individual has responsibility for both administering the program and planning and ensuring the implementation of the daily activities of a school-age program (Program Coordinator), the individual shall meet the staff requirements for an administrator and shall complete the BSAC training. This training can be accessed at https://www.swcdcinc.org/basic-school-age-care-bsac-resources or you can contact your local child care and resource referral agency for scheduling if available. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. WORKS Accounts and Staff Education All staff members must have a WORKS Account and the accounts must updated with the correct education information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. If you have any questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding any violations documented during today's visit. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-102 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/26/2023 Number Present: 25 Completed Date: 10/27/2023 Age: From 0 To 4 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, with restrictions of daytime care only and children under 2 ½ years old in rooms with direct exits only. The building has four classrooms and one additional classroom in a second building. Heather Resendiz is the sole proprietor of the business. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals and snacks are prepared at the facility and children eat in classrooms. There are three playgrounds separated for infants/toddlers, preschoolers, and school age children. During today’s visit children present were observed to be engaged in outdoor play, indoor free choice activities, personal care routines, lunch, and rest time. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. In Space 5, a current activity plan was not posted for the school age children. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets not in use in Space 1 near an infant crib and Space 4 in a children's activity center were not covered with safety plug covers. 10A NCAC 09 .0604(c) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor in Space 1. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. In Space 1, two medication authorization forms for 2 different medications (Colic Calm and Gripe Water) for an enrolled infant were on file, but the actual medication on-site (Infant's Mylicon Gas Relief) was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the recommended manufacturers dosage listed on the bottle that was on-site by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Staff have not administered the medication on-site. 10A NCAC 09 .0803(4)(6-9) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. In Space 1, a six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. .0606(g) 9995 A violation was found for which there is no item number. In Space 4, a staff member's purse was observed on a shelf lower than five feet from the floor, a violation of Sanitation Rule 15A NCAC 18A .2820(g) Purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. 9996 A violation was found for which there is no item number. In Space 3, a training/sippy cup filled with milk was observed on top of the diaper changing table, a violation of Sanitation Rule 15A NCAC 18A .2819(b) Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good repair. Nothing shall be placed on the diapering surface except for those items required for diapering and the child whose diaper will be changed. If diapering is performed on the floor in a toilet room, then a smooth, intact, nonabsorbent barrier that is clean and in good repair shall be placed on the floor to minimize cross-contamination. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 9, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov, and include the name and ID# for the facility, date of the visit, date of the letter, each item# for each violation and a date each violation was corrected and how it was corrected, and sign the documentation. Each violation must be fully corrected. Documentation of compliance must note state that a violation will be corrected once other actions are taken. If you cannot correct the violation by November 9, 2023, please email Ms. Childress immediately, with the Item# of the violation, and explanation as to why it cannot be corrected, and you may request for additional time to be considered to allow you to correct the violation. You must be specific about the amount of time you would need and a date you feel the violation(s) will be corrected. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment were emailed to Ms. McCoy and Ms. Resendiz on August 21, 2023, and the forms were to be returned to me by October 16, 2023. The applications have not been received. Ms. McCoy stated that they wished to complete the Environment Rating Scale Assessment but were going to rearrange classrooms. We discussed the importance of seeking technical assistance to assist staff in preparing and that the applications forms must be submitted to request the assessments. The assessments must be completed in time for Ms. Childress to process the star rated license prior to the expiration of the temporary license. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Alleghany County Partnership for Children 61 Wee Care Avenue Sparta, NC 28675 336-372-2846 Website: alleghanychildren.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: During today’s visit, I reviewed with Ms. McCoy the DCDEE website and where to locate and how to use the item number listing along with Chapter 9 Child Care Rules. In the items listing you will see the child care rule, general statute and/or the sanitation rule which is applicable to each item. Violations documented today are regarding activity plans, medications, safe sleep policy and sanitation. It is recommended that the violations, applicable child care, general statute or sanitation rule be reviewed with all staff members as part of correcting the violations. Please reach out to Ms. Childress or the Alleghany Partnership for Children if you need assistance with consultation or training related to these rules. Daily Schedules and Activity Plans Item # 428- A current activity plan was not posted for the school age children. Requirements for activity plans intended to stimulate emotional and social development, health and physical development, approaches to play and learning, language development and communication, and cognitive development are important for all age groups of children, including school age children who may only be present for a short amount of time during the school year. Planned experiences that meet the developmental domains listed are important for school age children. Safety and Health Item # 812- When electrical outlets are not in use, and are accessible to children, they must be covered with safety plugs. During today’s visit one electrical outlet on the wall at the top of a child’s crib was not covered. We discussed that once a child could pull up and stand, the crib did not need to be placed near electrical outlets at all. Another uncovered outlet was observed in an activity center in the preschool classroom. All staff must re-cover outlets with safety plug covers after using them. Storage of Hazardous Items and Medication Item # 841- A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor. We discussed that Benadryl was not considered an emergency medication and must be in locked storage. Staff should look closely at all medications brought in by parents and store the medications as required. Sanitation Rule 15A NCAC 18A .2801(11) defines an emergency medication as medication needed to immediately treat a life-threatening medical event that is administered in accordance with 10A NCAC 09 .0803(10) and G.S. 110-102.1A. Item # 847- Parent’s medication authorization must include all required information. A parent had completed 2 medication authorization forms for 2 different medications (gas drops) for an enrolled infant, but the actual medication (gas drops) on-site was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the dosage listed on the bottle on-site and recommended by the manufacturer by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Again, staff must closely monitor the medication and authorization forms for any medication brought in to the center by parents. Safe Sleep Policies and Practices Item # 887- Visual checks for two sleeping infants were not conducted as required today. A six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. The purpose of visually checking infants while sleeping is to help reduce the risk of Sudden Infant Death Syndrome (SIDS) which is a leading cause of death among infants aged 12 months and younger. The facility safe sleep policy indicates that staff will visually check sleeping infants every 15 minutes and record the observations. Staff are currently supposed to use an application on their cell phones to record the safe sleep checks for each sleep infant. As evidenced by observations and in speaking with staff, they are not forgetting to enter the information on the app but rather they are not completing the visual checks at all. It is recommended that you immediately implement the use of a hardcopy Safe Sleep Chart form to be completed by staff as opposed to or in addition to opening the application and entering it in on their cell phones. An Infant Sleep Chart form is available on the DCDEE website at https://nchildcare.ncdhhs.gov under Provider Documents and Forms. Sanitation Rule 15A NCAC 18A .2820(b) & (g) Storage Purses and other personal belongings for all staff members must be placed where they are inaccessible to children. “Inaccessible” is defined as when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor regardless of the age of children in care. Sanitation Rule 15A NCAC 18A .2819(b) Diapering and Diaper Changing Facilities A training cup with a lid and spout filled with milk was observed on top of the diaper changing table. The cup was not labeled and the children and staff in the classroom were outside on the playground. Only the child who is receiving a diaper change and the items required for diaper changing can be on the diapering surface. When children are served meals and beverages, including milk, and the children finish eating, all cups and utensils must be immediately discarded or returned to the kitchen for cleaning and sanitizing. Cups of milk should not remain in the classroom after the completion of the meal with which it was served. Classroom Arrangement Relating to Supervision and Infant Safe Sleep During today’s visit, a staff member in the infant’s classroom was observed sitting in the floor with four infants and was engaged in play and conversation and one infant was asleep in a crib. The area where the staff member was sitting and the area where the infant was sleeping was separated by three low shelves and a long gate. The arrangement of the shelving prevented the staff member from being able to see the sleeping infant unless the staff member put effort into standing up or stretching up to see the infant. The gate was being used to prevent more mobile children from accessing the area where the infant was sleeping. The diapering area, sinks and food prep area with the refrigerator containing bottles was located on the side of the room where the infant was sleeping and is opposite of where the caregiver was sitting with the children who were awake. This may be a contributing factor as to why safe sleep checks are not being conducted. The placement of the shelving and gate separated the classrooms into two defined independent spaces. During pre-licensing the owner wanted the space to be divided into two classrooms. However, approval has not been received from sanitation. Ms. McCoy stated that she had considered rearranging the room with cribs all placed together on the right side of the room and moving the shelving. Based on observations today, in order for one caregiver to be able to provide personal care routines at different times, be able to conduct safe sleep checks, and supervise children appropriately, the caregiver would have to constantly move the entire group of infants from one area to another. Providing care is being compromised by the current arrangement of the shelves and gate. To immediately address the potential risk of the health and safety of children, Ms. Childress and Ms. McCoy discussed moving the shelves and the gate to open the classroom up and allow for movement and clear supervision. Ms. Childress assisted Ms. McCoy in rearranging the room. Ms. McCoy stated that she may continue to make changes to the space to allow staff to be able to supervise and care for children. Documentation regarding the final plans for room arrangement of this classroom must be submitted to Ms. Childress by November 9, 2023. Rated License Application and Request for Environment Rating Scale Assessments Rated License Application and request for the Environment Rating Scale Assessments Rated License Application and Request for Environment Rating Scale Assessments must be submitted to Ms. Childress no later than November 1, 2023. Building and Fire Inspections A building and fire inspection must be completed and submitted to Ms. Childress prior to the expiration of the temporary license. Failure to submit approved inspections will result in an administrative action not limited to a denial of a license to operate. Consultation: Health and Safety Training All staff must complete Health and Safety Trainings within one year of hire and must be repeated every five years with training certificates on file for review. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. This training is not counted as part of staff orientation. Orientation For New Staff/ New Staff Files/ CPR/FA and Trainings Health and safety training shall be in addition to the new staff orientation requirements. Orientation topics should be a review of the policies specific to your facility. All staff, including the director, must receive 16 hours of orientation. The orientation form is available on the DCDEE website www.ncchildcare.ncdhhs.gov under provider documents and forms. All new staff must complete CPR/FA training within 90 days of hire and the trainer must be an approved trainer. A list of approved instructors and agencies can be found at https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/cpr_first_aid_information_Revised_2022%20(1).pdf?ver=8LaabqtKa9JzfMR_Be60qA%3d%3d. Online only CPR/FA courses will not be accepted. The director and any child care provider in the infant classroom must complete ITS-SIDS training. Director(s) must complete the training within 90 days of hire and every three years thereafter. Staff working with infants must complete the training within 2 months of assuming caregiving responsibilities in the infant classroom and every three years thereafter. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff who are responsible for supervising groups of school-age children (group leaders) shall be at least 18 years of age and have a high school diploma or its equivalent prior to employment and shall complete the BSAC (Basic School Age Care) training. Staff who assist group leaders (assistant group leaders) shall be at least 16 years of age and shall complete the BSAC training. When an individual has responsibility for both administering the program and planning and ensuring the implementation of the daily activities of a school-age program (Program Coordinator), the individual shall meet the staff requirements for an administrator and shall complete the BSAC training. This training can be accessed at https://www.swcdcinc.org/basic-school-age-care-bsac-resources or you can contact your local child care and resource referral agency for scheduling if available. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. WORKS Accounts and Staff Education All staff members must have a WORKS Account and the accounts must updated with the correct education information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. If you have any questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding any violations documented during today's visit. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 10/26/2023 Number Present: 25 Completed Date: 10/27/2023 Age: From 0 To 4 Total Minutes: 300 Time In: 09:30 AM Time Out: 02:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today's unannounced visit was to monitor compliance with all applicable child care requirements during the second temporary time period visit and to discuss preparation for a rated license assessment. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this facility operates with a Temporary License, issued on July 14, 2023, with restrictions of daytime care only and children under 2 ½ years old in rooms with direct exits only. The building has four classrooms and one additional classroom in a second building. Heather Resendiz is the sole proprietor of the business. If any changes to the business type need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location or inherited. All designated indoor and outdoor spaces for child care were monitored, as well as all staff files and a percentage of children’s files. All program records and documents required to be posted were monitored. The facility does not provide transportation. Meals and snacks are prepared at the facility and children eat in classrooms. There are three playgrounds separated for infants/toddlers, preschoolers, and school age children. During today’s visit children present were observed to be engaged in outdoor play, indoor free choice activities, personal care routines, lunch, and rest time. The following violations were cited today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. In Space 5, a current activity plan was not posted for the school age children. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets not in use in Space 1 near an infant crib and Space 4 in a children's activity center were not covered with safety plug covers. 10A NCAC 09 .0604(c) 841 Medications including prescription and non-prescription items were not stored in a locked cabinet or other locked container. A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor in Space 1. 15A NCAC 18A .2820(d) 847 Parent's medication authorization did not include required information. In Space 1, two medication authorization forms for 2 different medications (Colic Calm and Gripe Water) for an enrolled infant were on file, but the actual medication on-site (Infant's Mylicon Gas Relief) was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the recommended manufacturers dosage listed on the bottle that was on-site by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Staff have not administered the medication on-site. 10A NCAC 09 .0803(4)(6-9) 887 Caregivers did not document compliance with visually checking on sleeping infants aged 12 months or younger and/or the documents were not maintained for a minimum of one month. In Space 1, a six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. .0606(g) 9995 A violation was found for which there is no item number. In Space 4, a staff member's purse was observed on a shelf lower than five feet from the floor, a violation of Sanitation Rule 15A NCAC 18A .2820(g) Purses and other personal effects belonging to child care center employees shall be kept inaccessible to children and shall be stored in accordance with this Rule, as applicable. 9996 A violation was found for which there is no item number. In Space 3, a training/sippy cup filled with milk was observed on top of the diaper changing table, a violation of Sanitation Rule 15A NCAC 18A .2819(b) Diapering surfaces shall be made of smooth, intact, nonabsorbent material and shall be kept clean and in good repair. Nothing shall be placed on the diapering surface except for those items required for diapering and the child whose diaper will be changed. If diapering is performed on the floor in a toilet room, then a smooth, intact, nonabsorbent barrier that is clean and in good repair shall be placed on the floor to minimize cross-contamination. All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress by November 9, 2023. The documentation should be submitted by email to Ms. Childress at tammy.childress@dhhs.nc.gov, and include the name and ID# for the facility, date of the visit, date of the letter, each item# for each violation and a date each violation was corrected and how it was corrected, and sign the documentation. Each violation must be fully corrected. Documentation of compliance must note state that a violation will be corrected once other actions are taken. If you cannot correct the violation by November 9, 2023, please email Ms. Childress immediately, with the Item# of the violation, and explanation as to why it cannot be corrected, and you may request for additional time to be considered to allow you to correct the violation. You must be specific about the amount of time you would need and a date you feel the violation(s) will be corrected. During today’s visit we again discussed the Rated License Assessment Process and the Environment Rating Scale Assessment. The application for a Star Rated License Assessment and Request for an Environment Rating Scale Assessment were emailed to Ms. McCoy and Ms. Resendiz on August 21, 2023, and the forms were to be returned to me by October 16, 2023. The applications have not been received. Ms. McCoy stated that they wished to complete the Environment Rating Scale Assessment but were going to rearrange classrooms. We discussed the importance of seeking technical assistance to assist staff in preparing and that the applications forms must be submitted to request the assessments. The assessments must be completed in time for Ms. Childress to process the star rated license prior to the expiration of the temporary license. You should prepare for the ERS Assessment by reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and review resource guides/additional notes/ informational videos and participate in the free online training. For technical assistance in preparing for the Environment Rating Scale Assessment, you may also contact your local resource and referral agency at: Alleghany County Partnership for Children 61 Wee Care Avenue Sparta, NC 28675 336-372-2846 Website: alleghanychildren.org Your Temporary License will expire on January 14, 2024, and in order to continue to operate you must be issued a star rated license. In order to continue to participate in the NC Subsidized Child Care Program, you must be issued a license with Three Stars or higher. Technical Assistance: During today’s visit, I reviewed with Ms. McCoy the DCDEE website and where to locate and how to use the item number listing along with Chapter 9 Child Care Rules. In the items listing you will see the child care rule, general statute and/or the sanitation rule which is applicable to each item. Violations documented today are regarding activity plans, medications, safe sleep policy and sanitation. It is recommended that the violations, applicable child care, general statute or sanitation rule be reviewed with all staff members as part of correcting the violations. Please reach out to Ms. Childress or the Alleghany Partnership for Children if you need assistance with consultation or training related to these rules. Daily Schedules and Activity Plans Item # 428- A current activity plan was not posted for the school age children. Requirements for activity plans intended to stimulate emotional and social development, health and physical development, approaches to play and learning, language development and communication, and cognitive development are important for all age groups of children, including school age children who may only be present for a short amount of time during the school year. Planned experiences that meet the developmental domains listed are important for school age children. Safety and Health Item # 812- When electrical outlets are not in use, and are accessible to children, they must be covered with safety plugs. During today’s visit one electrical outlet on the wall at the top of a child’s crib was not covered. We discussed that once a child could pull up and stand, the crib did not need to be placed near electrical outlets at all. Another uncovered outlet was observed in an activity center in the preschool classroom. All staff must re-cover outlets with safety plug covers after using them. Storage of Hazardous Items and Medication Item # 841- A bottle of Benadryl was in a zipper case with an Epi-Pen stored higher than 5 feet from the floor. We discussed that Benadryl was not considered an emergency medication and must be in locked storage. Staff should look closely at all medications brought in by parents and store the medications as required. Sanitation Rule 15A NCAC 18A .2801(11) defines an emergency medication as medication needed to immediately treat a life-threatening medical event that is administered in accordance with 10A NCAC 09 .0803(10) and G.S. 110-102.1A. Item # 847- Parent’s medication authorization must include all required information. A parent had completed 2 medication authorization forms for 2 different medications (gas drops) for an enrolled infant, but the actual medication (gas drops) on-site was not the brand documented by the parent on either of the 2 forms. The dosage on both of the forms completed by the parent exceeded the dosage listed on the bottle on-site and recommended by the manufacturer by over three to five times. The bottle on-site was not recommended for children under 2 years of age. One of the forms did not have a parent signature or date. Again, staff must closely monitor the medication and authorization forms for any medication brought in to the center by parents. Safe Sleep Policies and Practices Item # 887- Visual checks for two sleeping infants were not conducted as required today. A six-month-old slept for 32 minutes with one documented visual check and a four-month-old slept for 29 minutes with no visual check documented. The purpose of visually checking infants while sleeping is to help reduce the risk of Sudden Infant Death Syndrome (SIDS) which is a leading cause of death among infants aged 12 months and younger. The facility safe sleep policy indicates that staff will visually check sleeping infants every 15 minutes and record the observations. Staff are currently supposed to use an application on their cell phones to record the safe sleep checks for each sleep infant. As evidenced by observations and in speaking with staff, they are not forgetting to enter the information on the app but rather they are not completing the visual checks at all. It is recommended that you immediately implement the use of a hardcopy Safe Sleep Chart form to be completed by staff as opposed to or in addition to opening the application and entering it in on their cell phones. An Infant Sleep Chart form is available on the DCDEE website at https://nchildcare.ncdhhs.gov under Provider Documents and Forms. Sanitation Rule 15A NCAC 18A .2820(b) & (g) Storage Purses and other personal belongings for all staff members must be placed where they are inaccessible to children. “Inaccessible” is defined as when stored on a shelf or in an unlocked cabinet that is mounted a minimum vertical distance of five feet above the finished floor regardless of the age of children in care. Sanitation Rule 15A NCAC 18A .2819(b) Diapering and Diaper Changing Facilities A training cup with a lid and spout filled with milk was observed on top of the diaper changing table. The cup was not labeled and the children and staff in the classroom were outside on the playground. Only the child who is receiving a diaper change and the items required for diaper changing can be on the diapering surface. When children are served meals and beverages, including milk, and the children finish eating, all cups and utensils must be immediately discarded or returned to the kitchen for cleaning and sanitizing. Cups of milk should not remain in the classroom after the completion of the meal with which it was served. Classroom Arrangement Relating to Supervision and Infant Safe Sleep During today’s visit, a staff member in the infant’s classroom was observed sitting in the floor with four infants and was engaged in play and conversation and one infant was asleep in a crib. The area where the staff member was sitting and the area where the infant was sleeping was separated by three low shelves and a long gate. The arrangement of the shelving prevented the staff member from being able to see the sleeping infant unless the staff member put effort into standing up or stretching up to see the infant. The gate was being used to prevent more mobile children from accessing the area where the infant was sleeping. The diapering area, sinks and food prep area with the refrigerator containing bottles was located on the side of the room where the infant was sleeping and is opposite of where the caregiver was sitting with the children who were awake. This may be a contributing factor as to why safe sleep checks are not being conducted. The placement of the shelving and gate separated the classrooms into two defined independent spaces. During pre-licensing the owner wanted the space to be divided into two classrooms. However, approval has not been received from sanitation. Ms. McCoy stated that she had considered rearranging the room with cribs all placed together on the right side of the room and moving the shelving. Based on observations today, in order for one caregiver to be able to provide personal care routines at different times, be able to conduct safe sleep checks, and supervise children appropriately, the caregiver would have to constantly move the entire group of infants from one area to another. Providing care is being compromised by the current arrangement of the shelves and gate. To immediately address the potential risk of the health and safety of children, Ms. Childress and Ms. McCoy discussed moving the shelves and the gate to open the classroom up and allow for movement and clear supervision. Ms. Childress assisted Ms. McCoy in rearranging the room. Ms. McCoy stated that she may continue to make changes to the space to allow staff to be able to supervise and care for children. Documentation regarding the final plans for room arrangement of this classroom must be submitted to Ms. Childress by November 9, 2023. Rated License Application and Request for Environment Rating Scale Assessments Rated License Application and request for the Environment Rating Scale Assessments Rated License Application and Request for Environment Rating Scale Assessments must be submitted to Ms. Childress no later than November 1, 2023. Building and Fire Inspections A building and fire inspection must be completed and submitted to Ms. Childress prior to the expiration of the temporary license. Failure to submit approved inspections will result in an administrative action not limited to a denial of a license to operate. Consultation: Health and Safety Training All staff must complete Health and Safety Trainings within one year of hire and must be repeated every five years with training certificates on file for review. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. This training is not counted as part of staff orientation. Orientation For New Staff/ New Staff Files/ CPR/FA and Trainings Health and safety training shall be in addition to the new staff orientation requirements. Orientation topics should be a review of the policies specific to your facility. All staff, including the director, must receive 16 hours of orientation. The orientation form is available on the DCDEE website www.ncchildcare.ncdhhs.gov under provider documents and forms. All new staff must complete CPR/FA training within 90 days of hire and the trainer must be an approved trainer. A list of approved instructors and agencies can be found at https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/cpr_first_aid_information_Revised_2022%20(1).pdf?ver=8LaabqtKa9JzfMR_Be60qA%3d%3d. Online only CPR/FA courses will not be accepted. The director and any child care provider in the infant classroom must complete ITS-SIDS training. Director(s) must complete the training within 90 days of hire and every three years thereafter. Staff working with infants must complete the training within 2 months of assuming caregiving responsibilities in the infant classroom and every three years thereafter. At all times, one child care provider who has completed ITS-SIDS training shall be present in the infant room while children are in care. A certificate of each staff member's completion of this course shall be maintained in the staff member's file in the center. Staff who are responsible for supervising groups of school-age children (group leaders) shall be at least 18 years of age and have a high school diploma or its equivalent prior to employment and shall complete the BSAC (Basic School Age Care) training. Staff who assist group leaders (assistant group leaders) shall be at least 16 years of age and shall complete the BSAC training. When an individual has responsibility for both administering the program and planning and ensuring the implementation of the daily activities of a school-age program (Program Coordinator), the individual shall meet the staff requirements for an administrator and shall complete the BSAC training. This training can be accessed at https://www.swcdcinc.org/basic-school-age-care-bsac-resources or you can contact your local child care and resource referral agency for scheduling if available. Emergency Preparedness and Response Plan Emergency Preparedness and Response in Child Care training must be completed by at least one staff member (usually the administrator) within one year of the effective date of the initial license. Maintain documentation of this training. Once the EPR training is completed, you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. WORKS Accounts and Staff Education All staff members must have a WORKS Account and the accounts must updated with the correct education information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. If you have any questions about today’s visit, please contact Ms. Childress at tammy.burcham@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding any violations documented during today's visit. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0508 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0701 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0901 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0902 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1103 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. 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 .1803 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: LEARNING TREE CHILDCARE CENTER Facility ID: 03000072 Consultant: TAMMY CHILDRESS Operation Type: Center Case Number: Visit Date: 8/21/2023 Number Present: 23 Completed Date: 8/21/2023 Age: From 0 To 4 Total Minutes: 150 Time In: 10:30 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Temp Time Period Announced/Unannounced: Unannounced The purpose of today’s unannounced visit was to monitor compliance with all applicable child care requirements during the first temporary time visit, following an ownership change on July 14, 2023. The visit was conducted with Rachel McCoy, Director, by Tammy Childress, Lead Child Care Consultant. Currently this center operates with a Temporary License, issued on July 14, 2023, to operate first shift. The facility is licensed to provide care to children ages zero to twelve-years-old and is approved to operate four classrooms within the main building and one additional classroom in an attached second building (connected by outdoor roofing and a ramp). Restrictions are daytime care only and children under 2 ½ years old in rooms with direct exits. Heather H. Resendiz is the sole proprietor of the business. If any changes to the corporation need to be made or you decide to sale your business, then you must notify your consultant at least thirty days prior to any changes occurring. The license cannot be bought, sold, subleased, transferred to another person or location, or inherited. Two classrooms with children ages infant to four-years-old were monitored during the visit. All program records, documents required to be posted, and a sampling of staff and children’s files were monitored. The outdoor learning environment was monitored today including all fencing/gates, surfacing and equipment. During the Pre-Licensing Visit on June 30, 2023, it was determined there was a third playground at the facility, which had not been measured by the consultant assigned to the previous program. During today’s visit, the playground (Playground 3), was measured, entered on a space calculation sheet to determine. The facility does not provide transportation. Meals and snacks are prepared at the facility and the children eat all food in the classrooms. During today’s visit children present were observed to be engaged in outdoor play, free choice activities, personal care routines and lunch. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The activity plans for children ages infant to one-years-old was not dated and did not include 5 names of children enrolled in the classroom. The activity plan for children ages three to five-years-old was dated August 14, 2023 through August 18, 2023. GS 110-91(12); .0508(a) 526 Menus for all meals and snacks were not current or posted where easily seen by parents and cook. The menu for the current week was not posted in the facility or kitchen. 10A NCAC 09 .0901(b) 540 An individual written feeding plan was not provided by child's parent or health care provider or was not followed and posted. Individual feeding plans were not posted for two children under the age of 15 months in the classroom where the children receive care. 10A NCAC 09 .0902(a) 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. Grass and weeds were overgrown along the interior and exterior fence lines and around playground equipment. Rubber mulch piled beneath one interior and one exterior fence gate resulted in the gates being off center and leaving gaps. A cat was observed on the playgrounds during the visit. White chipping paint was observed on the lower half of he building on the preschool children's playground. 15A NCAC 18A .2832(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. A tube of Aquaphor for an enrolled child expired May 2021. .0803(12) 859 Monthly playground inspections were not completed and/or they were not completed by an individual trained in playground safety requirements. The facility was issued a Temporary License on July 14, 2023, and a monthly playground inspection had not been documented as of August 21, 2023. .0605(q) 1032 Child care providers and uncompensated providers who are not substitute providers or volunteers, including the director did not have a medical report on file prior to employment that was signed by a health care professional and/ or the medical report was older than 12 months. Three staff members did not have a medical report completed prior to employment. 10A NCAC 09 .0701(a) 1033 On or before the first day of work, all staff, including the director and individuals who volunteer more than once per week did not provide results indicating that they were free of active TB and/or TB test or screening was older than 12 months. One staff person, hired August 4, 2023, did not have negative TB test results on file. .0701(a) 1043 All staff records, except financial records, were not made available for review. Staff records for three staff members were not available for review. G.S. 110-91( 9) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one enrolled child was not fully completed by the child's parent or health care professional. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. There was no medication authorization permission form completed for a tube of Walgreen's Baby Healing Ointment for one enrolled child and there was no medication authorization permission form for one enrolled child's albuterol inhaler. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) All violations must be corrected immediately. You must submit documentation on how each violation was corrected to Ms. Childress no later than September 4, 2023. The documentation must include how each violation was corrected and should be submitted by email at tammy.childress@dhhs.nc.gov. Correction documentation completion was reviewed with Ms. McCoy today. Your compliance history affects the star rating. It is imperative that staff maintain compliance with child care rules and requirements at all times. Violations of child care requirements affect the facility’s compliance history. You must maintain a minimum compliance history of seventy-five (75) percent. During today’s visit we discussed the two-component rated license process to assist the administrator and owner in deciding if they wish to request a Rated License Assessment and an Environment Rating Scale Assessment in order to obtain a 3-5 star rated license. Begin reviewing the Early Childhood Environment Rating Scale (revised edition) booklets, visit the North Carolina Rated License Assessment Project website at www.ncrlap.org and contact your local resource and referral agency for additional resources and technical assistance. The NCRLAP website offers training and additional notes on topics such as activity areas, indoor and outdoor materials, daily schedules, sanitation, and interactions. The application for a Rated License and a request form for the Environment Rating Scale Assessment were emailed to Ms. McCoy, and Heather Resendiz, owner, with the visit summary. Please complete and return these forms to Ms. Childress by October 16, 2023. The type of Star Rated License issued to you program will result from the points earned in the Program Component (overall score from the ERS Assessments and meeting enhanced ratios and/or space requirements), Staff Education, and a Quality Point. Please ensure that all staff members have a WORKS Account and are updated with their correct educational information. The information on each staff member’s WORKS Qualification Letter and what is shown in the DCDEE WORKS system is what will be used to determine the points in education for your license. Instructions for the DCDEE WORKS system is located in the DCDEE website at https://ncchildcare.ncdhhs.gov. Technical Assistance and/or Consultation was provided during today’s visit on the following: Administering Medication and Medical Action Plans It is recommended that medication permissions are placed with each medication. Medication administration forms and permissions must contain all required information and be completed in full by the parent and/or health care provider as required. All medications must be labeled with the child’s name to whom it belongs. Child Care Rule 10A NCAC 09 .1803 The following provisions apply to the administration of medication in child care centers: (1) No prescription or over-the-counter medication and no topical, non-medical ointment, repellent, lotion, cream, fluoridated toothpaste, or powder shall be administered to any child: (a) without written authorization from the child's parent; (b) without written instructions from the child's parent, physician, or other health professional; (c) in any manner not authorized by the child's parent, physician, or other health professional; (d) after its expiration date; (e) for non-medical reasons, such as to induce sleep; or (f) with a known allergy to the medication. (6) A parent may give a caregiver standing authorization for up to six months to administer prescription or over-the-counter medication to a child, when needed, for chronic medical conditions, such as asthma, and for allergic reactions. The authorization shall be in writing and shall contain: (a) the child's name; (b) the subject medical conditions or allergic reactions; (c) the names of the authorized over-the-counter medications; (d) the criteria for the administration of the medication; (e) the amount and frequency of the dosages; (f) the manner in which the medication shall be administered; (g) the signature of the parent; (h) the date the authorization was signed by the parent; and (i) the length of time the authorization is valid, if less than six months. Infant Nutrition 10A NCAC 09 .0902 REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center with an individual written feeding plan for the child. This plan shall be followed at the center. This plan shall include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's plan shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall include the type and amount of milk, formula and food, the frequency of feedings and be posted for reference by the caregivers. Nutrition Standards 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (b) When food is prepared by or provided by the center, menus for nutritious meals and snacks shall be planned at least one week in advance. At least one dated copy of the current week's menu shall be posted where it can be seen by parents and food preparation staff when food is prepared or provided by the center. A variety of food shall be included in meals and snacks. Any substitution shall be of comparable food value and shall be recorded on the menu prior to the meal or snack being served. Activity Plans 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) All centers shall have a current schedule and activity plan for each group of children posted for reference by parents and by caregivers. The schedule and activity plan may be combined in a single document. (b) For each group of children in care, the activity plan shall include activities intended to stimulate the following developmental domains, in accordance with North Carolina Foundations for Early Learning and Development, available on the Division's website at http://ncchildcare.nc.gov/providers/pv_foundations.asp: (c) When children are in care and weather conditions permit, there shall be outdoor time, either as part of a small group, a whole group, or individual activity (1) emotional and social development; (2) health and physical development; (3) approaches to play and learning; (4) language development and communication; and (5) cognitive development. (d) When children three years old or older are in care, the schedule shall include the following: (1) blocks of time assigned to types of activities, including periods of time for active play, quiet play, or rest; (2) times and activities that are developmentally appropriate for the children in care; and (3) daily opportunities indoors and outdoors for: (A) free-choice activities; and (B) teacher-directed activities. (e) For children under two years old, interspersed among the daily events shall be individualized caregiving routines such as eating, napping, and toileting. (f) When children under three years old are in care, the schedule shall include regular daily events such as the arrival and departure of the children, free-choice times, outside time, and teacher-directed activities. (g) The activity plan shall: (1) identify activities that allow children to choose to participate with the whole group, part of the group, or independent of the group; (2) reflect that the children have four different activities daily, at least one of which is outdoors, if weather conditions permit, as listed in G.S. 110-91(12) as follows: (A) art and other creative play; (B) children's books; (C) blocks and block building; (D) manipulatives; and (E) family living and dramatic play; and (3) include a daily gross motor activity that may occur indoors or outdoors. Health and Safety Training All staff must complete Recognizing and Responding to Child Maltreatment training within 90 days of hire, and this training is accessible through Moodle on the DCDEE website. Ensure that all staff complete all of the required Health and Safety trainings within one year of hire. These trainings can be accessed on the DCDEE website at https://ncchildcare.ncdhhs.gov under the Provider tab from the home screen, select Training and Professional Development, and finally DCDEE Moodle. If you need assistance in locating the trainings, please contact me. It is important to remember that the child care administrator and all staff members must complete the specific Health and Safety Training called “Recognizing and Responding to Suspicions of Child Maltreatment”, within 90 days of employment. This training can be accessed through Moodle or directly at https://www.preventchildabusenc.org/services/trainings-and-professional-development/rrcourse. On-Going Professional Development If staff complete approved college courses in child development, for every one college credit hour (CEU) completed staff will earn 16 hours of on-going training. All staff must complete the required number of on-going training hours based upon education and experience within one year of hire and annually. The required number of training hours can be determined for each staff member using the information provided in Child Care Rule 10A NCAC 09 .1103. Register with Department of Justice You must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register on line at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Emergency Preparedness and Response Plan Emergency Preparedness and Response Training in Child Care must be completed within one year of licensure. You may contact your local child care resource and referral agency for assistance in obtaining this training. Once the training has been completed and you must complete an EPR Plan on a template at the following website https://rmp.nc.gov/portal/portal.aspx within four (4) months. A copy of the EPR plan must be printed and on file at the facility for review. After you complete the Emergency Preparedness and Response in Child Care training, you must conduct either a shelter-in-place or a lockdown drill every three months. Use the Emergency Drill Log to document these additional drills as well as the fire drills. The form is located under the Provider Documents tab on the DCDEE website at www.ncchildcare.ncdhhs.gov. The EPR Plan will be reviewed with all staff upon hire during orientation, whenever changes to the plan occur, and at least yearly. The date of the review of the plan with staff should be documented on the Staff and Training Worksheets. In addition, the administrator must review the plan annually in the portal and make updates if required. Once reviewed, print off the first page of the plan which will reflect the date of the review. Fire drills must be conducted and documented monthly. Inspections During the six (6) month Temporary License Time Period, you will be responsible for obtaining new Building, Fire, and Sanitation Inspections for the center. This may mean bringing the building into compliance with the current codes in each of these areas, regardless of the center’s current operational status. Failure to submit the three (3) approved inspection reports by the end of the Temporary License Time Period could result in issuance of a Provisional License or Denial of a License. DCDEE Contacts Please sign up to receive DCDEE email blasts by going to www.ncchildcare.ncdhhs.gov and completing the “Sign Up for Updates” information at the bottom of the home page. Register With the Department of Justice If you have not, you must register with the Department of Justice to receive e-mail or phone call notification if a sex offender moves into your area. To register, call 1-877-627-2826 or you may register online at: http://sexoffender.ncdoj.gov/. To reference the law concerning Sex offender and Public Protection Registration Programs you may go to: http://www.ncleg.net/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_14/Article_27A.html. Contact the local Sheriff's Department if a sex offender email or phone notification is received from the NC Sex Offender Registry. Child Care Rules, Types of Visits, and Monitoring Use the following links to learn more about expectations for childcare and monitoring visits: NC General Statutes https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_110_General_Statutes_Child_Care_Facilities.pdf?ver=2020-11-02-103947-617 NC Child Care Requirements (Child Care Rules) https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/C/Chapter_9_Rule_Changes_Effective_07-1-2023.pdf?ver=8v_6mYHBKAITAGicrIPyKw%3d%3d Monitoring Requirements for Child Care Centers https://ncchildcare.ncdhhs.gov/Portals/0/documents/pdf/M/Monitoring_ReguirementsforCenter.pdf?ver=2017-05-16-105805-143 This information can also be found on the DCDEE website at https://ncchildcare.ncdhhs.dov under the “Provider” tab and then selecting “Child Care Rules.” It is recommended that you work with staff and/or seek technical assistance from your local resource and referral agencies on how to complete activity plans, voice tones when speaking with children (not saying "no'), and on the importance of supervision of children which means moving about the indoor and outdoor areas and interacting with children rather than staying in a seated position. Complete daily checks of the outdoor area and ensure that gates are fully closed and that mulch is covering the bottom poles of the fences and bottom pieces of equipment. Document monthly outdoor inspections. All staff and children's files must be available for review at all times. In addition, documents such as arrival and departure times, attendance, and safe sleep checks must be available for review at all times. If these documents are electronic or maintained on an application and cannot be accessed during a visit, repeated violations will be documented. A summary of today’s was reviewed with and provided to Ms. McCoy and a copy emailed to Ms. Resendiz. If you have any further questions about today’s visit, please contact Ms. Childress at tammy.childress@dhhs.nc.gov or by telephone at (336)317-6436. You may also contact the Licensing Supervisor, Pamela Hauser, at pamela.hauser@dhhs.nc.gov if you have concerns regarding today’s visit or any violations documented. 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