10A NCAC 09 .0901 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/24/2024 Number Present: 61 Completed Date: 5/24/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 11:30 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Sarah Upton, Child Care Consultant and also signed by Holly Smith, Administrative Assistant. Pam Ashe, Owner, was not present for my full visit. Ms. Ashe did come by the facility briefly and gave Ms. Smith verbal permission to sign today’s visit summary. I did speak with Ms. Ashe about the violations that would be written today. Ms. Ashe was given the opportunity to ask questions. A copy of the visit summary was left with Ms. Smith. The following items were monitored today: Supervision Staff Child Ratios CPR First Aid Special Training Criminal Record Checks Completed Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted Permit Restrictions Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions –meets enhanced ratio; meets enhanced space The last annual compliance visit was conducted on January 26, 2024 The last fire drill was practiced on May 10, 2024 The last emergency drill (lockdown) was practiced on April 12, 2024.. The Emergency Medical Care plan was posted and current. You reported today that one (1) new teacher was hired on May 06, 2024. The new teachers file was reviewed during this visit for application, medical, TB, orientation, signed policies, and qualification letter. I observed children during free play, routine care needs, lunch, which consisted of broccoli, cucumbers, cheese sticks, bananas, and milk and naptime. All interactions observed were positive and helpful. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were written: Violation Number Comment Rule 303 Children were not adequately supervised at all times. As I entered the classroom for children one year of age there were six (6) one year olds sitting at the two (2) tables eating lunch. Three (3) children were sitting at the table closest to the door and three (3) children at the table pushed up to the wall. There was one (1) teacher in the classroom, and she was observed putting out children’s cots. In the classroom for two-through-three-year-olds there were sixteen (16) children with two (2) teachers. Children were observed eating lunch. One (1) teacher was observed standing by the table near the door and could see the children eating at the table directly in front of her and children that were facing towards her. The other teacher was observed putting out cots. There were several children sitting table at the table near the sink and at the table near the diaper changing table that were sitting with their back turned towards the teacher that was standing and she could not see them. Because teachers in both classrooms were involved in other activities and not positioned where all children could be seen and heard while eating, adequate supervision was not provided during meals. .1801(a)(1-5) 1792 Staff did not model appropriate eating behaviors by consuming food or beverages that meet the nutritional requirements specified in the Meal Patterns for Children in Child Care Programs in the presence of children in care. During my walk through of the classrooms it was noted that in the classroom for children ages two-through-three year of age there was a bottle of diet mountain dew sitting on a high shelf. .0901(i) Technical Assistance: Item #303 While children are eating teacher(s) must be positioned so they can see AND hear children. According to 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item #1792 all food and beverages consumed in the presence of children shall meet the nutritional requirements. Items such as sodas, candy and fast food. If staff choose to consume such items it needs to be done so when not in the presence of children. Additionally, items need to be kept out of the view of children in the classroom. According to 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. Corrective Action Plan All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. **Another visit will be made to ensure that this violation regarding supervision is being corrected. Consultation: If you would like assistance with classroom behavior and classroom management I encourage you to reach out to Sharon Fitzgerald, Healthy Social Behavior Specialist, at Fitzgerald.sharon@swcdcinc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .1801 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/24/2024 Number Present: 61 Completed Date: 5/24/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 11:30 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Sarah Upton, Child Care Consultant and also signed by Holly Smith, Administrative Assistant. Pam Ashe, Owner, was not present for my full visit. Ms. Ashe did come by the facility briefly and gave Ms. Smith verbal permission to sign today’s visit summary. I did speak with Ms. Ashe about the violations that would be written today. Ms. Ashe was given the opportunity to ask questions. A copy of the visit summary was left with Ms. Smith. The following items were monitored today: Supervision Staff Child Ratios CPR First Aid Special Training Criminal Record Checks Completed Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted Permit Restrictions Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions –meets enhanced ratio; meets enhanced space The last annual compliance visit was conducted on January 26, 2024 The last fire drill was practiced on May 10, 2024 The last emergency drill (lockdown) was practiced on April 12, 2024.. The Emergency Medical Care plan was posted and current. You reported today that one (1) new teacher was hired on May 06, 2024. The new teachers file was reviewed during this visit for application, medical, TB, orientation, signed policies, and qualification letter. I observed children during free play, routine care needs, lunch, which consisted of broccoli, cucumbers, cheese sticks, bananas, and milk and naptime. All interactions observed were positive and helpful. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were written: Violation Number Comment Rule 303 Children were not adequately supervised at all times. As I entered the classroom for children one year of age there were six (6) one year olds sitting at the two (2) tables eating lunch. Three (3) children were sitting at the table closest to the door and three (3) children at the table pushed up to the wall. There was one (1) teacher in the classroom, and she was observed putting out children’s cots. In the classroom for two-through-three-year-olds there were sixteen (16) children with two (2) teachers. Children were observed eating lunch. One (1) teacher was observed standing by the table near the door and could see the children eating at the table directly in front of her and children that were facing towards her. The other teacher was observed putting out cots. There were several children sitting table at the table near the sink and at the table near the diaper changing table that were sitting with their back turned towards the teacher that was standing and she could not see them. Because teachers in both classrooms were involved in other activities and not positioned where all children could be seen and heard while eating, adequate supervision was not provided during meals. .1801(a)(1-5) 1792 Staff did not model appropriate eating behaviors by consuming food or beverages that meet the nutritional requirements specified in the Meal Patterns for Children in Child Care Programs in the presence of children in care. During my walk through of the classrooms it was noted that in the classroom for children ages two-through-three year of age there was a bottle of diet mountain dew sitting on a high shelf. .0901(i) Technical Assistance: Item #303 While children are eating teacher(s) must be positioned so they can see AND hear children. According to 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item #1792 all food and beverages consumed in the presence of children shall meet the nutritional requirements. Items such as sodas, candy and fast food. If staff choose to consume such items it needs to be done so when not in the presence of children. Additionally, items need to be kept out of the view of children in the classroom. According to 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. Corrective Action Plan All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. **Another visit will be made to ensure that this violation regarding supervision is being corrected. Consultation: If you would like assistance with classroom behavior and classroom management I encourage you to reach out to Sharon Fitzgerald, Healthy Social Behavior Specialist, at Fitzgerald.sharon@swcdcinc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 5/24/2024 Number Present: 61 Completed Date: 5/24/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 11:30 AM Time Out: 03:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor compliance during a Routine Unannounced visit. A computerized generated report of today’s visit was completed, reviewed with you, and signed by Sarah Upton, Child Care Consultant and also signed by Holly Smith, Administrative Assistant. Pam Ashe, Owner, was not present for my full visit. Ms. Ashe did come by the facility briefly and gave Ms. Smith verbal permission to sign today’s visit summary. I did speak with Ms. Ashe about the violations that would be written today. Ms. Ashe was given the opportunity to ask questions. A copy of the visit summary was left with Ms. Smith. The following items were monitored today: Supervision Staff Child Ratios CPR First Aid Special Training Criminal Record Checks Completed Emergency Medical Care Plan Administration of Medication Storage of Hazardous Substances Storage of Medication Adequate/Approved Space General Safety Discipline Program Records License Posted Permit Restrictions Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions –meets enhanced ratio; meets enhanced space The last annual compliance visit was conducted on January 26, 2024 The last fire drill was practiced on May 10, 2024 The last emergency drill (lockdown) was practiced on April 12, 2024.. The Emergency Medical Care plan was posted and current. You reported today that one (1) new teacher was hired on May 06, 2024. The new teachers file was reviewed during this visit for application, medical, TB, orientation, signed policies, and qualification letter. I observed children during free play, routine care needs, lunch, which consisted of broccoli, cucumbers, cheese sticks, bananas, and milk and naptime. All interactions observed were positive and helpful. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were written: Violation Number Comment Rule 303 Children were not adequately supervised at all times. As I entered the classroom for children one year of age there were six (6) one year olds sitting at the two (2) tables eating lunch. Three (3) children were sitting at the table closest to the door and three (3) children at the table pushed up to the wall. There was one (1) teacher in the classroom, and she was observed putting out children’s cots. In the classroom for two-through-three-year-olds there were sixteen (16) children with two (2) teachers. Children were observed eating lunch. One (1) teacher was observed standing by the table near the door and could see the children eating at the table directly in front of her and children that were facing towards her. The other teacher was observed putting out cots. There were several children sitting table at the table near the sink and at the table near the diaper changing table that were sitting with their back turned towards the teacher that was standing and she could not see them. Because teachers in both classrooms were involved in other activities and not positioned where all children could be seen and heard while eating, adequate supervision was not provided during meals. .1801(a)(1-5) 1792 Staff did not model appropriate eating behaviors by consuming food or beverages that meet the nutritional requirements specified in the Meal Patterns for Children in Child Care Programs in the presence of children in care. During my walk through of the classrooms it was noted that in the classroom for children ages two-through-three year of age there was a bottle of diet mountain dew sitting on a high shelf. .0901(i) Technical Assistance: Item #303 While children are eating teacher(s) must be positioned so they can see AND hear children. According to 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. Item #1792 all food and beverages consumed in the presence of children shall meet the nutritional requirements. Items such as sodas, candy and fast food. If staff choose to consume such items it needs to be done so when not in the presence of children. Additionally, items need to be kept out of the view of children in the classroom. According to 10A NCAC 09 .0901 GENERAL NUTRITION REQUIREMENTS (j) Staff shall role model appropriate eating behaviors by consuming only food or beverages that meet the nutritional requirements specified in Paragraph (a) of this Rule in the presence of children in care. Corrective Action Plan All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. **Another visit will be made to ensure that this violation regarding supervision is being corrected. Consultation: If you would like assistance with classroom behavior and classroom management I encourage you to reach out to Sharon Fitzgerald, Healthy Social Behavior Specialist, at Fitzgerald.sharon@swcdcinc.org. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0304 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

Open Not marked corrected in the state record

Category: supervision. Open / not marked corrected.

10A NCAC 09 .0803 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1102 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1703 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1801 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2830 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-90 · Violation

Name of Operation: Pam's Child Development Center, LLC Facility ID: 50000109 Consultant: SARAH UPTON Operation Type: Center Case Number: Visit Date: 1/26/2024 Number Present: 61 Completed Date: 1/26/2024 Age: From 0 To 5 Total Minutes: 360 Time In: 10:15 AM Time Out: 04:15 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 compliance during an annual compliance visit. A computerized generated report of today’s visit could not be completed during my visit today due to the system locking me out and not allowing me to sign onto my computer. After several attempts and calls to NCID to unlock my password, I did not have enough time to complete on site, travel back to my headquarters and stay within my working time hours. I had personal plans for after hours and could not stay over. I discussed with Pam Ashe, Administrator, the violations that would be written in this visit summary and that a summary would be sent to her. Kelly Nicewonger, Environmental Health Specialist arrived at the faclity shortly after I had arrived and conducted an inspection. Today, Ms. Ashe was available to answer any question and assist me as needed. The indoor and outdoor areas were monitored today, including supervision, staff/child ratios, permit restrictions, discipline, nutrition and routine caregiving activities. An annual compliance monitoring checklist for child care centers was used to note the requirements monitored and is attached to the computerized generated visit summary for your records. The program’s compliance history was ninety-five (95) percent after today’s visit. Permit type – Five Star issued on June 13, 2023 Special Services/Restrictions – Meets enhanced space; Meets enhanced ratios. The last annual compliance visit was conducted on February 01, 2023 The last fire drill was practiced on January 11, 2024. The last shelter-in-place drill was practiced on January 15, 2024. The last fire inspection was approved on June 19, 2023. The last sanitation inspection was conducted on January 26, 2024 with twelve (12) demerits for a provisional rating. The Emergency Medical Care plan was posted and current. The approved curriculum for four-year-old children is Mother Goose. Staff and Training Worksheets were not completed prior to my visit. Another visit will be made on Thursday February 1st, 2024 to review staff files and children’s files. Upon arrival I introduced my presence to Holly Smith, Administrative Assistant, and explained the reason for my visit. Ms. Ashe was not present upon my arrival but arrived shortly. The children in the classroom for four-to-five-year-old were observed eating lunch and preparing for nap. The children in the classroom for one-year-old were observed during routine care needs and lunch. The children in the classroom for two-year-old were observed eating lunch and preparing for nap. The children in the classroom for infants were observed during free play. I used the Child Care Center Item Number Listing (DCDEE-0357) as a basic monitoring tool to assess compliance with all applicable child care requirements pertinent to this facility. For specific rule references, refer to Chapter 110 General Statues Child Care Facilities, Chapter nine (9) Child Care Rule (10A NCAC 09) and Section 2800 Sanitation of Child Care Center (15A NCAC 18A) for additional information. Updated copies of these rules can be located on our website at https://ncchildcare.ncdhhs.gov/ The following violations were documented during today’s visit. Violation Number Comment Rule 303 Children were not adequately supervised at all times. In the classroom for children aged one year of age children were observed sitting at the table eating while the two teachers were observed at the food cart with their backs turned towards the children fixing plates and children's milk cups. In the classroom for children two years of age three teachers were observed putting out mats, assisting children at the sink, helping children to their cots and involved in other activities turning their backs to the children that were still at the tables eating. .1801(a)(1-5) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. In the classroom for children under one year of age there was a tube of prescribed diapering cream not stored in the original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional .0803(2)(a) 847 Parent's medication authorization did not include required information. In the classroom for children under one year of age there was a tube of diapering cream without parent’s medication authorization. In the classroom for children one year of age there was a container of diapering cream without parent’s medication authorization. 10A NCAC 09 .0803(4)(6-9) 1065 Child care providers scheduled to work in the infant room, did not complete ITS-SIDS training within two months of employment or did not complete the training every three years. Child care administrators did not complete the ITS-SIDS training within 90 days of employment and every three years thereafter. After review of the staff and training worksheet it was noted that a floater that works in the infant room had not completed the required ITS-SIDS training. .1102(f) Technical assistance: Item 303 All children must be adequately supervised at all times. Teachers need to place themselves in an area where they can see all the children sitting at the table eating. Lunchtime should not be used as a time to clean up toys, putting out cots or any other activities that take teachers away from children eating. If there are more than one teacher in the classroom then one teacher should remain close by the tables and positioned where they can see all children. As we discussed today choking is silent and that is why it is so important that children can be seen while eating. According 10A NCAC 09 .1801 SUPERVISION IN CHILD CARE CENTERS (a) Children shall be adequately supervised at all times in child care centers. Adequate supervision shall mean that: (1) staff must be positioned in the indoor and outdoor environment to maximize their ability to hear or see the children at all times and render assistance; (2) staff must interact with the children while moving about the indoor or outdoor area; (3) staff must know where each child is located and be aware of the children's activities at all times; (4) staff must provide supervision appropriate to the individual age, needs, and capabilities of each child; and (5) staff must be able to see and hear children aged birth to five years old while the children are eating. All of the conditions in this Paragraph shall apply except when emergencies necessitate that adequate supervision is impossible. Documentation of emergencies shall be maintained and available for review by Division representatives upon request. Item #844 All prescribed medications need to be in the original container or box with the pharmacy label. This includes any prescribed diapering creams. According 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS The following provisions apply to the administration of medication in child care centers: (2) Prescribed medications: (a) shall be stored in the original containers in which they were dispensed with the pharmacy labels; (b) if pharmaceutical samples, shall be stored in the manufacturer's original packaging, shall be labeled with the child's name, and shall be accompanied by written instructions specifying: (i) the child's name; (ii) the names of the medication; (iii) the amount and frequency of dosage; (iv) the signature of the prescribing physician or other health professional; and (v) the date the instructions were signed by the physician or other health professional; (c) shall be administered only to the child for whom they were prescribed; and (d) shall be administered according to the prescription, using amount and frequency of dosage specified on the label. (3) A parent's written authorization for the administration of a prescription medication described in Item (2) of this Rule shall be valid for the length of time the medication is prescribed to be taken. Item 847 any over-the-counter medication must be accompanied by written authorization from the child’s parent/legal guardian before it can be administered. According to 10A NCAC 09 .0803 ADMINISTERING MEDICATION IN CHILD CARE CENTERS 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. (4) Over-the-counter medications, such as cough syrup, decongestant, acetaminophen, ibuprofen, topical antibiotic cream for abrasions, or medication for intestinal disorders shall be stored in the manufacturer's original packaging on which the child's name is written or labeled and shall be accompanied by written instructions specifying: (a) the child's name; (b) the names of the authorized over-the-counter medication; (c) the amount and frequency of the dosages, which shall not exceed the amount and frequency of the dosages on the manufacturer's label; (d) the signature of the parent, physician or other health professional; and (e) the date the instructions were signed by the parent, physician or other health professional. The permission to administer over-the-counter medications is valid for up to 30 days at a time, except as allowed in Items (6), (7), (8) and (9) of this Rule. Over-the-counter medications shall not be administered on an "as needed" basis, other than as allowed in Items (6), (7), (8) and (9) of this Rule. Corrective Action Plan: All violations are required to be corrected immediately. However, if at any time you are unable to correct all violations within the specified time frame, please send a written statement regarding those violations that were corrected and include a specific plan for correction of the remaining violations. Please be aware that any written information submitted by you regarding correction of violations documented during today’s visit would be considered as legal documentation. Therefore, it is important that all information submitted be accurate and truthful. Please be aware that if it is determined that information submitted was inaccurate or willfully falsified, an Administrative Action, including Revocation of the facility’s license may be issued. The violations documented above must be corrected immediately. Send me a letter of compliance describing in detail specifically how each violation was corrected and how compliance will be maintained in the future. Include the following: • Facility name • Facility ID# • Date of visit • Violation item number • Statement of compliance I must receive your compliance statement by February 09, 2024 Email the compliance letter on signed letterhead or on the email identifying your facility name, ID#, name and position to: Sarah.Upton@ dhhs.nc.gov or you can mail to: Department of Health and Human Services Division of Child Development and Early Education Attn: Sarah Upton 143 Bobcat Trail Clyde NC 28721 Please call me at 828-782-0937, or email sarah.upton@dhhs.nc.gov, if you need assistance. Please note: if mailing the letter of compliance, I must receive by the due date listed above. You will need to mail a compliance statement three to five days prior to the due date to ensure receipt within the designated timeline. Failure to correct the violations and send the written statement by the due date listed above may result in an unannounced follow-up visit being conducted. Based on Child Care Rule 10A NCAC 09 Section .2200, the Division of Child Development may take administrative action against the license and/or impose civil penalties based on the failure of the operator to correct any documented violations within the established time period. Falsification of any information may result in a revocation of your license. You must maintain at least 75% Compliance History for each 18-month period as required by G.S. 110-90(4) (c). Please note any violations cited today and during future visits will negatively impact your compliance history. Repeated violations or violations left unresolved may lead to an administrative action. Consultation is provided as follows: If you have any questions or concerns regarding the Stabilization Grant, please contact Kaitlyn Marshall, Child Care Consultant, at 828-713-8192 or email kaitlyn.marshall@dhhs.nc.gov. If you elect to change and/or alter any previously approved spaces used by children as indicated on the approved indoor and outdoor floor plan, you will need to contact me within thirty (30) days prior to the change. Failure to notify me, may result in a violation of child care requirements. Child Care Rule 10A NCAC 09 .0304(a) states “Each operator shall schedule and obtain a fire inspection within 12 months of the center's previous fire inspection. The operator shall notify the local fire inspector when it is time for the center's annual fire inspection. The operator shall submit the original of the approved annual fire inspection report to the Division within one week of the inspection visit on the form provided by the Division.” As child care providers, you are a vital part in the prevention and intervention of child maltreatment. You may see potential indicators of maltreatment in the children under your care. Some children may even be more likely to disclose maltreatment to a child care provider than to a family member. It is required that all providers are aware of maltreatment indicators and to report any suspicions of maltreatment. Follow child care rules related to child maltreatment training: 10A NCAC 09 .1102(g) and 10A NCAC 09 .1703(a)(5) states the child care administrator, operator, and all staff members shall complete Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. Child Care Rule 10A NCAC 09 .2830 MAINTAINING THE STAR RATING (a)A representative of the Division may make announced or unannounced visits to facilities to assess on-going compliance with the requirements of a star rating after it has been issued. It is the center operator’s responsibility to make sure each staff person has registered for a WORKS account, submit an official transcript (if applicable) and apply for a position for evaluation. This should be completed immediately upon hiring or at the latest, by the end of the six-week orientation process. Failure to maintain the same education point level may result in a violation of the above rule reference and may result in a reduction of stars. Child Care Rule 10A NCAC 09 .2830 (c) If employment-related changes occur at a facility that result in the operator not complying with the standards in the Section for the star rating issued, the operator shall correct the noncompliance within 120 days. If the operator does not correct the noncompliance within 120 days, the operator shall notify the Division. It is your responsibility to understand the health and safety requirements in child care rule .1102. If the program is out of compliance in accordance with health and safety requirements, Child Care Development Block Grant (CCDBG), it may affect subsidy funding. Stay updated with changes and new rule updates by visiting the DCDEE website at https://ncchildcare.ncdhhs.gov/.It is your responsibility to understand the rules and laws that are applicable your program. All rules/laws cannot be verbally reviewed during any licensing visit. Please ask questions if you are having difficulty and would like additional technical assistance. I welcome your questions and want to be a resource for you. Please continue to visit DCDEE’s website to get the latest COVID-19 information for child care at https://ncchildcare.ncdhhs.gov/. We appreciate all you are doing to serve the children and families of NC. If you have questions, please contact me at sarah.upton@dhhs.nc.gov or 828.782.0937, or Bonnie Mathis, Licensing Supervisor, at bonnie.mathis@dhhs.nc.gov If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times