Bethlehem Community Child Development Center

10A NCAC 09 .0606 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: 0225-062L Visit Date: 2/11/2025 Number Present: 3 Completed Date: 2/11/2025 Age: From 0 To 1 Total Minutes: 135 Time In: 11:30 AM Time Out: 01:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced An unannounced visit was made to this center today to investigate allegations made in a complaint to the Raleigh office. This visit was conducted with Ms. Deborah Forrest, Director and staff. The complaint allegations are as follows: There is a concern that the infant safe-sleep policy was not followed. An infant was placed on their stomach to sleep. I have interviewed office staff and classroom staff today. I have observed the posted items in the classroom, the cribs and sleeping spaces, the SIDS policies and parent’s signed forms, and staff files concerning SIDS training. I have spoken with the director and current staff about laying babies on their backs to sleep and the centers procedures and policies regarding this matter. I have observed teachers interacting with babies today. Ms. Forrest stated that on 01-24-2025 a staff person in the baby room laid an infant who was awake on their stomach to play. She then attended to other children in the room. While the teacher was attending to other children, the infant who was placed on their stomach fell asleep on their stomach on the floor. The parent of the child arrived to pick up the child and asked why the child was asleep on their stomach. Ms. Forrest reports that neither of the staff persons who were assigned to work in the baby room are still working here because of this situation. She stated also that the staff may have occasionally placed babies on their stomachs to sleep but wrote on the safe sleep form that the child was placed on their back to sleep. Ms. Forrest stated that to place a child on their stomach to sleep or to place a child on their stomach to sleep and document that the child was placed on their back to sleep is against this child care’s policies and procedures. She stated that the staff in the infant room were not following the center policies and procedures at the time of the incident. Ms. Forrest stated that most current staff are trained on Infant Safe Sleep Policies and that most staff have current SIDS training. I have observed the SIDS training chart and the staff that do not have current SIDS trainings are teachers in the preschool classrooms who are with children ages 3 to 5 years old. Ms. Forrest stated that the child who was asleep on their stomach on the day of the incident does not attend this child care center anymore. I have pointed out to Ms. Forrest that the signed Safe Sleep policy attached to each crib in the baby room is blank; the boxes on the form that state the centers policies and procedures regarding safe sleep have not been checked. All of the forms for each child have the parent signature on the form. I have pointed out to Ms. Forrest that there is no safe sleep poster on the wall in the infant room. In addition, the lesson plan on the wall for the infants was dated for January. These two items were corrected during the visit when the safe sleep poster and the lesson plan for February were posted on the wall. Both of the former teachers in this classroom had current SIDS trainings and both of the current teachers in the infant room have current SIDS training. I have observed the training certificates for all four staff persons. Ms. Forrest showed me the Safe Sleep Documentation Sheet today for the date of the incident and I pointed out to her that the form has checked that the child was laid on their stomach to sleep all the way down the page, however “awake” is only written beside the lines two times. Ms. Forrest stated that she believed the documentation page was changed by the teachers after the incident, because she said she went into the classroom to observe the paper after she heard the complaint and the paper had “back” checked, even though the child was laid on its stomach. She stated that she believed the teachers changed the form after she pointed out to them that the child was not laid on its back, but on its stomach. Based on observations, paperwork and staff report, there was not enough information to confirm this allegation. This allegation is unsubstantiated. The following violations were documented today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The lesson plan for January was posted in the infant room. GS 110-91(12); .0508(a) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. There was no safe sleep poster on the wall in the infant room. .0606(b) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy that was given to each parent of a child in the infant room was blank and not filled out with the center policies, although each parent had signed the form. 10A NCAC 09 .0606(c) I have asked Ms. Forrest to send me written documentation by February 25, 2025 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. In addition, I have told Ms. Forrest today that I will make another visit to the child care center to observe the infant room children and staff, and to view posted items and forms concerning SIDS and safe sleep. Consultation: I have reminded Ms. Forrest that violations concerning safe sleep are very serious, as a child could become injured or die if laid on their stomach or side to sleep, or if a child was unable to breathe. Ms. Forrest agreed that this situation was very serious and stated that this was the reason that the staff involved in the incident no longer worked at the center. She stated that she would speak with all staff regarding this subject at the next staff meeting as well. Technical Assistance: There was a safe sleep poster in the office that was taken to the infant room and posted during the visit. Ms. Forrest stated that she did not know what happened to the poster that was on the wall in the room previously. I have reviewed the Safe Sleep Policy that the center is using with Ms. Forrest and the staff person who is in charge of forms. I told them that it is a good idea to use the form on the Division’s website, which they are currently using, but that they must read the form as Administrators, decide together which parts of the form apply to the center, and check the appropriate boxes. After an original is filled out and discussed with staff, the altered copy (with the center policies completed) is the form that should be given to parents to sign. Ms. Forrest pointed out to me today that the lesson plan for the infants for February was underneath the January one, which had not been removed. Comments: Both of the teachers in the classroom today stated that they knew that infants must be laid on their back to sleep. Both teachers were filling out the safe sleep documentation for each child present properly today. I have reviewed this visit summary with Ms. Forrest at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: 0225-062L Visit Date: 2/11/2025 Number Present: 3 Completed Date: 2/11/2025 Age: From 0 To 1 Total Minutes: 135 Time In: 11:30 AM Time Out: 01:45 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced An unannounced visit was made to this center today to investigate allegations made in a complaint to the Raleigh office. This visit was conducted with Ms. Deborah Forrest, Director and staff. The complaint allegations are as follows: There is a concern that the infant safe-sleep policy was not followed. An infant was placed on their stomach to sleep. I have interviewed office staff and classroom staff today. I have observed the posted items in the classroom, the cribs and sleeping spaces, the SIDS policies and parent’s signed forms, and staff files concerning SIDS training. I have spoken with the director and current staff about laying babies on their backs to sleep and the centers procedures and policies regarding this matter. I have observed teachers interacting with babies today. Ms. Forrest stated that on 01-24-2025 a staff person in the baby room laid an infant who was awake on their stomach to play. She then attended to other children in the room. While the teacher was attending to other children, the infant who was placed on their stomach fell asleep on their stomach on the floor. The parent of the child arrived to pick up the child and asked why the child was asleep on their stomach. Ms. Forrest reports that neither of the staff persons who were assigned to work in the baby room are still working here because of this situation. She stated also that the staff may have occasionally placed babies on their stomachs to sleep but wrote on the safe sleep form that the child was placed on their back to sleep. Ms. Forrest stated that to place a child on their stomach to sleep or to place a child on their stomach to sleep and document that the child was placed on their back to sleep is against this child care’s policies and procedures. She stated that the staff in the infant room were not following the center policies and procedures at the time of the incident. Ms. Forrest stated that most current staff are trained on Infant Safe Sleep Policies and that most staff have current SIDS training. I have observed the SIDS training chart and the staff that do not have current SIDS trainings are teachers in the preschool classrooms who are with children ages 3 to 5 years old. Ms. Forrest stated that the child who was asleep on their stomach on the day of the incident does not attend this child care center anymore. I have pointed out to Ms. Forrest that the signed Safe Sleep policy attached to each crib in the baby room is blank; the boxes on the form that state the centers policies and procedures regarding safe sleep have not been checked. All of the forms for each child have the parent signature on the form. I have pointed out to Ms. Forrest that there is no safe sleep poster on the wall in the infant room. In addition, the lesson plan on the wall for the infants was dated for January. These two items were corrected during the visit when the safe sleep poster and the lesson plan for February were posted on the wall. Both of the former teachers in this classroom had current SIDS trainings and both of the current teachers in the infant room have current SIDS training. I have observed the training certificates for all four staff persons. Ms. Forrest showed me the Safe Sleep Documentation Sheet today for the date of the incident and I pointed out to her that the form has checked that the child was laid on their stomach to sleep all the way down the page, however “awake” is only written beside the lines two times. Ms. Forrest stated that she believed the documentation page was changed by the teachers after the incident, because she said she went into the classroom to observe the paper after she heard the complaint and the paper had “back” checked, even though the child was laid on its stomach. She stated that she believed the teachers changed the form after she pointed out to them that the child was not laid on its back, but on its stomach. Based on observations, paperwork and staff report, there was not enough information to confirm this allegation. This allegation is unsubstantiated. The following violations were documented today: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The lesson plan for January was posted in the infant room. GS 110-91(12); .0508(a) 892 The center's safe sleep policy was not posted in a prominent place in the infant room where parents and caregivers were able to view daily. There was no safe sleep poster on the wall in the infant room. .0606(b) 893 A copy of the safe sleep policy was not given to and/or explained to the parent of each child on or before the first day the infant attended the center. The safe sleep policy that was given to each parent of a child in the infant room was blank and not filled out with the center policies, although each parent had signed the form. 10A NCAC 09 .0606(c) I have asked Ms. Forrest to send me written documentation by February 25, 2025 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. In addition, I have told Ms. Forrest today that I will make another visit to the child care center to observe the infant room children and staff, and to view posted items and forms concerning SIDS and safe sleep. Consultation: I have reminded Ms. Forrest that violations concerning safe sleep are very serious, as a child could become injured or die if laid on their stomach or side to sleep, or if a child was unable to breathe. Ms. Forrest agreed that this situation was very serious and stated that this was the reason that the staff involved in the incident no longer worked at the center. She stated that she would speak with all staff regarding this subject at the next staff meeting as well. Technical Assistance: There was a safe sleep poster in the office that was taken to the infant room and posted during the visit. Ms. Forrest stated that she did not know what happened to the poster that was on the wall in the room previously. I have reviewed the Safe Sleep Policy that the center is using with Ms. Forrest and the staff person who is in charge of forms. I told them that it is a good idea to use the form on the Division’s website, which they are currently using, but that they must read the form as Administrators, decide together which parts of the form apply to the center, and check the appropriate boxes. After an original is filled out and discussed with staff, the altered copy (with the center policies completed) is the form that should be given to parents to sign. Ms. Forrest pointed out to me today that the lesson plan for the infants for February was underneath the January one, which had not been removed. Comments: Both of the teachers in the classroom today stated that they knew that infants must be laid on their back to sleep. Both teachers were filling out the safe sleep documentation for each child present properly today. I have reviewed this visit summary with Ms. Forrest at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .3009 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 10/22/2024 Number Present: 131 Completed Date: 10/22/2024 Age: From 0 To 5 Total Minutes: 240 Time In: 09:00 AM Time Out: 01:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced visit was conducted at this child care today to monitor compliance with all applicable childcare requirements. This visit was conducted with Ms. LaRae Lavalleur, Assistant Administrator, and Ms. Pamela Hauser, Licensing Supervisor. This program currently operates with a Five Star license. Restrictions include first and second shift, meets enhanced ratios, meets enhanced space. The license was posted and the restrictions were being followed. The NC Secretary of State website was reviewed on 10/21/2024. The program’s compliance history was 85% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit we observed children playing with toys, having circle time, eating lunch and playing outdoors. The last annual compliance visit was conducted on 11/06/2023. The last sanitation inspection was conducted on 06-25-2024. The last fire inspection was conducted on 06-04-2024. A fire drill was documented on 09-20-2024. A shelter in place drill was documented on 08-30-2024. An outdoor inspection was documented on 09-25-2024. I observed program records and posted items today. I observed staff and children’s records today according to DCDEE procedures. I observed the storage of hazardous items and cleaning supplies. I observed both the storage of medications and the administration of medication paperwork. This program does not provide transportation. Ms. Lavalleur reports that there are no school age children enrolled at this program. The NC Pre-K requirements in section .3000 of the childcare rules were monitored for compliance. Staff-child ratios and maximum group sizes required in Child Care Rule 10A NCAC 09 .3009 were verified to be in compliance. The NC Pre-K staff education was monitored. A selection of files were monitored for completed health assessments and developmental screenings. This site uses Dial 4, Teaching Strategies Gold and Creative Curriculum and these were viewed today. I documented the following violations during today’s visit: Violation Number Comment Rule 811 Potentially hazardous items including but not limited to power tools, nails, chemicals, propane stoves, lawn mowers, gasoline, or kerosene were not stored in locked areas, removed from the premises, or made inaccessible to children. There were gallon size bags used for storage in several classrooms. These were removed when we pointed out that when empty, they can be put over a child's head, posing a suffocation hazard. There were four bottles of shaving cream in unlocked storage in space 1. These were removed from the classroom and taken to the office. .0604(a) 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. There was a bag of fast food on the desk in the space 1 that belonged to the teacher. .0901(i) I have asked Ms. Lavalleur to send me written documentation by November 5, 2024 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Lavalleur that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. I provided the following Consultation during today’s visit: We have reminded Ms. Lavalleur today that the emergency medicines must go with children from room to room as they transition; for example, allergy medicines from the NC Pre-K classroom must transition to the wrap-around room with the child. During today’s visit, Ms. Hauser discussed with Ms. Lavalleur that in space 14, or any rooms where sippy cups are utilized by children, staff should send any prepared sippy cups back with the kitchen staff when they come to pick up breakfast trays. Staff may consider preparing cups when children arrive, instead of ahead of time. The classroom has extra sippy cups in the cabinet and milk in the refrigerator so that if children arrive late for breakfast, they can prepare a cup of milk to serve. If cups remain in the refrigerator, they must be labeled and dated with the child’s name. I have reviewed this visit summary with Ms. Lavalleur at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Lavalleur’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: JACLYN FLOWE Operation Type: Center Case Number: 0624-222A Visit Date: 6/26/2024 Number Present: 100 Completed Date: 6/26/2024 Age: From 0 To 5 Total Minutes: 340 Time In: 10:00 AM Time Out: 03:40 PM Time In: Time Out: List to Use: Center Type Of Visit: Complaint Visit Announced/Unannounced: Unannounced The purpose of this unannounced visit was to investigate allegations of violations of child care requirements at this child care facility. LaRae Lavalleur, assistant administrator, accompanied me during a walk-through of the facility. During the visit, I discussed the allegations with Ms. Lavalleur, and additional staff members. Limited monitoring of child care requirements occurred during today’s visit. Violation Number Comment Rule 902 Each child was not attended to in a nurturing and appropriate manner, or in keeping with the child's developmental needs. On 6/17/24, a staff member failed to attend to an 11-month-old child in a nurturing and appropriate manner, when the staff member lifted the child off the ground by one arm. G.S. 110-91(10) You may contact me, Jaclyn Flowe, Investigations Consultant, at phone number 704-495-5363, email at jaclyn.flowe@dhhs.nc.gov, or you may contact Elizabeth Nichols, North Central Investigations Team Supervisor, at elizabeth.nichols@dhhs.nc.gov. Thank you for your time. If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 5/1/2024 Number Present: 149 Completed Date: 5/1/2024 Age: From 0 To 5 Total Minutes: 420 Time In: 09:30 AM Time Out: 01:30 PM Time In: 12:30 PM Time Out: 03:30 PM List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit is to monitor this program for compliance with applicable requirements for a Routine Unannounced Visit. This visit was conducted with Ms. Deborah Forrest, Director. This program currently operates with a Five Star license. The license was posted and the restrictions were being followed. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least 75%. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit, the children were playing with toys, going outdoors, eating lunch and napping. Today, the following items were monitored: • Supervision • Capacity • CPR / First Aid • SIDS training • Criminal Background Checks • General health • Administration of medication • Storage of hazardous products • Storage of medication • General safety • General license requirements • Program records • License posted • Fire safety • Sanitation Limited monitoring of staff files was conducted in accordance with DCDEE procedures for the purpose of reviewing CPR and First Aid, EPR, SIDS training, Health and Safety trainings and Criminal Background Checks. The storage and administration of medications was monitored. Medication authorization was monitored. The storage of hazardous items was monitored. A fire drill was documented on 04-24-2024. A shelter in place drill was documented on 02-28-2024. An outdoor inspection was documented on 04-23-2024. This program does not provide transportation. The following violations were documented during this visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The lesson plan was dated for last week in space 12. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. One outlet was uncovered and within reach of children in space 14. Five outlets were uncovered and within reach of children in space 8. 10A NCAC 09 .0604(c) 895 Infants under the age of 12 months were not placed on their backs for sleeping unless the center had obtained the appropriate written waiver. One child had been placed on his stomach to sleep in space 7. .0606(a)(1)(A-B) 1301 Center did not maintain a record of daily attendance. Today's attendance had been crossed through in space 13. GS 110-91(9) I have asked Ms. Forrest to send me written documentation by May 15, 2024 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Today I provided Technical Assistance in the following areas: I have told Ms. Forrest and staff that if a parent brings a tired or sleeping infant to day care and lays the child on their stomach to sleep, the staff can remind the parent that children must be laid on their backs to sleep at child care. The staff should turn over children that are laid on their stomachs by the parent to their backs to sleep. Consultation: Ms. Forrest and I have discussed her discipline policy, staff report about discipline and my observations today. Per staff report, the center only uses redirection as discipline with children, however, during the visit, a child was brought to the office and he sat in a small chair. Shortly thereafter, he was returned to the classroom. Some time later, the same child was brought back to the office and sat in the chair again. I asked if the child could accompany Ms. Forrest and I as we walked around the center. The child walked with us as we looked around the center. The child’s mother arrived and took the child home during my observations. Ms. Forrest and I disagreed about the child sitting in the chair in the office. I stated that the child was sitting in time out, and Ms. Forrest said the child was not sitting in time out. I have observed the discipline policy for the center in a child’s file. The file that I observed had a signed parent statement that said the parent had received the center discipline policy. Behind that piece of paper was DCDEE’s Discipline Policy from the website, however the paper was blank and was not filled in or signed by the parent. When I asked what discipline policy the parent was given and had signed that they had received, a staff person in the office pulled out a different discipline policy from the filing cabinet. The policy had a paragraph that discussed children and “time in” but did not have a definition of what “time in” means or what actions staff would take to use “time in” with a child. I told Ms. Forrest that the policy does not describe what time in means and asked her revisit the center’s current discipline policy and possibly re-write it to reflect what the center staff actually does when a child is misbehaving. Ms. Forrest stated several times that she knew that time out was not allowed to be used with children in child care and stated that she thought this was listed in the NC Rules for Child Care. I told Ms. Forrest that we would look at the Rules for Discipline together today. The section of the Rule Book that concern discipline are as follows: .1722 Prohibited Discipline (a) No child shall be subjected to any form of corporal punishment by the family child care home operator, additional caregiver, substitute provider, or any other person in the home, whether or not these persons reside in the home as follows: (1) No child shall be handled roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking; (2) No child shall ever be placed in a locked room, closet, or box, or be left alone in a room separated from staff; (3) No discipline shall ever be delegated to another child; (4) No food shall be withheld or given as a means of punishment or reward; (5) No child shall ever be disciplined for toileting accidents; (6) No child shall ever be disciplined for not sleeping during rest period; (7) No child shall be disciplined by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms or floors, or emptying diaper pails; (8) Physical activity, such as running laps and doing push-ups, shall not be withheld or required as punishment; (9) No child shall ever be yelled at, shamed, humiliated, frightened, threatened, or bullied; and (10) No child shall be restrained as a form of discipline unless the child's safety or the safety of others is at risk. For purposes of this Rule, "restraining" shall mean that a caregiver physically holds a child in a manner that restricts the child's movement, for a minimum amount of time necessary to ensure a safe environment. Children shall not be restrained through the use of heavy objects, including a caregiver's body, or any device such as straps, blankets, car seats, or cribs. (b) Discipline practices shall be age and developmentally appropriate. History Note: Authority G.S. 110-85; 110-91(10); 143B-168.3; Eff. July 1, 1998; Amended Eff. April 1, 2003; April 1, 2001; Readopted Eff. October 1, 2017. I have pointed out to Ms. Forrest today that the Rule book does not prohibit placing a child in time out. I have also mentioned to her that today I observed the following occurring: "11. DO use short supervised periods of time-out sparingly." The above is listed on the state’s Discipline policy, under “WE DO”, number 11. This document can be found on the Division's website under "Provider Documents and Forms" and was in a child's file at the center today, however, it was not signed. Today I observed a five year old child sitting in time out in the office with several adults present in the room , for approximately 2 minutes, before he went back to his classroom with an adult. The staff reported that the child was hitting, kicking and biting the teacher; another staff reported that the child was screaming at the teacher. This child was put in time out. Ms. Forrest stated that she will revisit the Discipline Policy for the center. I have reviewed this visit summary with Ms. Forrest at the conclusion of the visit and a copy was given to her. I appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 Kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-85 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 5/1/2024 Number Present: 149 Completed Date: 5/1/2024 Age: From 0 To 5 Total Minutes: 420 Time In: 09:30 AM Time Out: 01:30 PM Time In: 12:30 PM Time Out: 03:30 PM List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit is to monitor this program for compliance with applicable requirements for a Routine Unannounced Visit. This visit was conducted with Ms. Deborah Forrest, Director. This program currently operates with a Five Star license. The license was posted and the restrictions were being followed. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least 75%. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit, the children were playing with toys, going outdoors, eating lunch and napping. Today, the following items were monitored: • Supervision • Capacity • CPR / First Aid • SIDS training • Criminal Background Checks • General health • Administration of medication • Storage of hazardous products • Storage of medication • General safety • General license requirements • Program records • License posted • Fire safety • Sanitation Limited monitoring of staff files was conducted in accordance with DCDEE procedures for the purpose of reviewing CPR and First Aid, EPR, SIDS training, Health and Safety trainings and Criminal Background Checks. The storage and administration of medications was monitored. Medication authorization was monitored. The storage of hazardous items was monitored. A fire drill was documented on 04-24-2024. A shelter in place drill was documented on 02-28-2024. An outdoor inspection was documented on 04-23-2024. This program does not provide transportation. The following violations were documented during this visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The lesson plan was dated for last week in space 12. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. One outlet was uncovered and within reach of children in space 14. Five outlets were uncovered and within reach of children in space 8. 10A NCAC 09 .0604(c) 895 Infants under the age of 12 months were not placed on their backs for sleeping unless the center had obtained the appropriate written waiver. One child had been placed on his stomach to sleep in space 7. .0606(a)(1)(A-B) 1301 Center did not maintain a record of daily attendance. Today's attendance had been crossed through in space 13. GS 110-91(9) I have asked Ms. Forrest to send me written documentation by May 15, 2024 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Today I provided Technical Assistance in the following areas: I have told Ms. Forrest and staff that if a parent brings a tired or sleeping infant to day care and lays the child on their stomach to sleep, the staff can remind the parent that children must be laid on their backs to sleep at child care. The staff should turn over children that are laid on their stomachs by the parent to their backs to sleep. Consultation: Ms. Forrest and I have discussed her discipline policy, staff report about discipline and my observations today. Per staff report, the center only uses redirection as discipline with children, however, during the visit, a child was brought to the office and he sat in a small chair. Shortly thereafter, he was returned to the classroom. Some time later, the same child was brought back to the office and sat in the chair again. I asked if the child could accompany Ms. Forrest and I as we walked around the center. The child walked with us as we looked around the center. The child’s mother arrived and took the child home during my observations. Ms. Forrest and I disagreed about the child sitting in the chair in the office. I stated that the child was sitting in time out, and Ms. Forrest said the child was not sitting in time out. I have observed the discipline policy for the center in a child’s file. The file that I observed had a signed parent statement that said the parent had received the center discipline policy. Behind that piece of paper was DCDEE’s Discipline Policy from the website, however the paper was blank and was not filled in or signed by the parent. When I asked what discipline policy the parent was given and had signed that they had received, a staff person in the office pulled out a different discipline policy from the filing cabinet. The policy had a paragraph that discussed children and “time in” but did not have a definition of what “time in” means or what actions staff would take to use “time in” with a child. I told Ms. Forrest that the policy does not describe what time in means and asked her revisit the center’s current discipline policy and possibly re-write it to reflect what the center staff actually does when a child is misbehaving. Ms. Forrest stated several times that she knew that time out was not allowed to be used with children in child care and stated that she thought this was listed in the NC Rules for Child Care. I told Ms. Forrest that we would look at the Rules for Discipline together today. The section of the Rule Book that concern discipline are as follows: .1722 Prohibited Discipline (a) No child shall be subjected to any form of corporal punishment by the family child care home operator, additional caregiver, substitute provider, or any other person in the home, whether or not these persons reside in the home as follows: (1) No child shall be handled roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking; (2) No child shall ever be placed in a locked room, closet, or box, or be left alone in a room separated from staff; (3) No discipline shall ever be delegated to another child; (4) No food shall be withheld or given as a means of punishment or reward; (5) No child shall ever be disciplined for toileting accidents; (6) No child shall ever be disciplined for not sleeping during rest period; (7) No child shall be disciplined by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms or floors, or emptying diaper pails; (8) Physical activity, such as running laps and doing push-ups, shall not be withheld or required as punishment; (9) No child shall ever be yelled at, shamed, humiliated, frightened, threatened, or bullied; and (10) No child shall be restrained as a form of discipline unless the child's safety or the safety of others is at risk. For purposes of this Rule, "restraining" shall mean that a caregiver physically holds a child in a manner that restricts the child's movement, for a minimum amount of time necessary to ensure a safe environment. Children shall not be restrained through the use of heavy objects, including a caregiver's body, or any device such as straps, blankets, car seats, or cribs. (b) Discipline practices shall be age and developmentally appropriate. History Note: Authority G.S. 110-85; 110-91(10); 143B-168.3; Eff. July 1, 1998; Amended Eff. April 1, 2003; April 1, 2001; Readopted Eff. October 1, 2017. I have pointed out to Ms. Forrest today that the Rule book does not prohibit placing a child in time out. I have also mentioned to her that today I observed the following occurring: "11. DO use short supervised periods of time-out sparingly." The above is listed on the state’s Discipline policy, under “WE DO”, number 11. This document can be found on the Division's website under "Provider Documents and Forms" and was in a child's file at the center today, however, it was not signed. Today I observed a five year old child sitting in time out in the office with several adults present in the room , for approximately 2 minutes, before he went back to his classroom with an adult. The staff reported that the child was hitting, kicking and biting the teacher; another staff reported that the child was screaming at the teacher. This child was put in time out. Ms. Forrest stated that she will revisit the Discipline Policy for the center. I have reviewed this visit summary with Ms. Forrest at the conclusion of the visit and a copy was given to her. I appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 Kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 5/1/2024 Number Present: 149 Completed Date: 5/1/2024 Age: From 0 To 5 Total Minutes: 420 Time In: 09:30 AM Time Out: 01:30 PM Time In: 12:30 PM Time Out: 03:30 PM List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit is to monitor this program for compliance with applicable requirements for a Routine Unannounced Visit. This visit was conducted with Ms. Deborah Forrest, Director. This program currently operates with a Five Star license. The license was posted and the restrictions were being followed. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least 75%. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit, the children were playing with toys, going outdoors, eating lunch and napping. Today, the following items were monitored: • Supervision • Capacity • CPR / First Aid • SIDS training • Criminal Background Checks • General health • Administration of medication • Storage of hazardous products • Storage of medication • General safety • General license requirements • Program records • License posted • Fire safety • Sanitation Limited monitoring of staff files was conducted in accordance with DCDEE procedures for the purpose of reviewing CPR and First Aid, EPR, SIDS training, Health and Safety trainings and Criminal Background Checks. The storage and administration of medications was monitored. Medication authorization was monitored. The storage of hazardous items was monitored. A fire drill was documented on 04-24-2024. A shelter in place drill was documented on 02-28-2024. An outdoor inspection was documented on 04-23-2024. This program does not provide transportation. The following violations were documented during this visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. The lesson plan was dated for last week in space 12. GS 110-91(12); .0508(a) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. One outlet was uncovered and within reach of children in space 14. Five outlets were uncovered and within reach of children in space 8. 10A NCAC 09 .0604(c) 895 Infants under the age of 12 months were not placed on their backs for sleeping unless the center had obtained the appropriate written waiver. One child had been placed on his stomach to sleep in space 7. .0606(a)(1)(A-B) 1301 Center did not maintain a record of daily attendance. Today's attendance had been crossed through in space 13. GS 110-91(9) I have asked Ms. Forrest to send me written documentation by May 15, 2024 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Today I provided Technical Assistance in the following areas: I have told Ms. Forrest and staff that if a parent brings a tired or sleeping infant to day care and lays the child on their stomach to sleep, the staff can remind the parent that children must be laid on their backs to sleep at child care. The staff should turn over children that are laid on their stomachs by the parent to their backs to sleep. Consultation: Ms. Forrest and I have discussed her discipline policy, staff report about discipline and my observations today. Per staff report, the center only uses redirection as discipline with children, however, during the visit, a child was brought to the office and he sat in a small chair. Shortly thereafter, he was returned to the classroom. Some time later, the same child was brought back to the office and sat in the chair again. I asked if the child could accompany Ms. Forrest and I as we walked around the center. The child walked with us as we looked around the center. The child’s mother arrived and took the child home during my observations. Ms. Forrest and I disagreed about the child sitting in the chair in the office. I stated that the child was sitting in time out, and Ms. Forrest said the child was not sitting in time out. I have observed the discipline policy for the center in a child’s file. The file that I observed had a signed parent statement that said the parent had received the center discipline policy. Behind that piece of paper was DCDEE’s Discipline Policy from the website, however the paper was blank and was not filled in or signed by the parent. When I asked what discipline policy the parent was given and had signed that they had received, a staff person in the office pulled out a different discipline policy from the filing cabinet. The policy had a paragraph that discussed children and “time in” but did not have a definition of what “time in” means or what actions staff would take to use “time in” with a child. I told Ms. Forrest that the policy does not describe what time in means and asked her revisit the center’s current discipline policy and possibly re-write it to reflect what the center staff actually does when a child is misbehaving. Ms. Forrest stated several times that she knew that time out was not allowed to be used with children in child care and stated that she thought this was listed in the NC Rules for Child Care. I told Ms. Forrest that we would look at the Rules for Discipline together today. The section of the Rule Book that concern discipline are as follows: .1722 Prohibited Discipline (a) No child shall be subjected to any form of corporal punishment by the family child care home operator, additional caregiver, substitute provider, or any other person in the home, whether or not these persons reside in the home as follows: (1) No child shall be handled roughly in any way, including shaking, pushing, shoving, pinching, slapping, biting, kicking, or spanking; (2) No child shall ever be placed in a locked room, closet, or box, or be left alone in a room separated from staff; (3) No discipline shall ever be delegated to another child; (4) No food shall be withheld or given as a means of punishment or reward; (5) No child shall ever be disciplined for toileting accidents; (6) No child shall ever be disciplined for not sleeping during rest period; (7) No child shall be disciplined by assigning chores that require contact with or use of hazardous materials, such as cleaning bathrooms or floors, or emptying diaper pails; (8) Physical activity, such as running laps and doing push-ups, shall not be withheld or required as punishment; (9) No child shall ever be yelled at, shamed, humiliated, frightened, threatened, or bullied; and (10) No child shall be restrained as a form of discipline unless the child's safety or the safety of others is at risk. For purposes of this Rule, "restraining" shall mean that a caregiver physically holds a child in a manner that restricts the child's movement, for a minimum amount of time necessary to ensure a safe environment. Children shall not be restrained through the use of heavy objects, including a caregiver's body, or any device such as straps, blankets, car seats, or cribs. (b) Discipline practices shall be age and developmentally appropriate. History Note: Authority G.S. 110-85; 110-91(10); 143B-168.3; Eff. July 1, 1998; Amended Eff. April 1, 2003; April 1, 2001; Readopted Eff. October 1, 2017. I have pointed out to Ms. Forrest today that the Rule book does not prohibit placing a child in time out. I have also mentioned to her that today I observed the following occurring: "11. DO use short supervised periods of time-out sparingly." The above is listed on the state’s Discipline policy, under “WE DO”, number 11. This document can be found on the Division's website under "Provider Documents and Forms" and was in a child's file at the center today, however, it was not signed. Today I observed a five year old child sitting in time out in the office with several adults present in the room , for approximately 2 minutes, before he went back to his classroom with an adult. The staff reported that the child was hitting, kicking and biting the teacher; another staff reported that the child was screaming at the teacher. This child was put in time out. Ms. Forrest stated that she will revisit the Discipline Policy for the center. I have reviewed this visit summary with Ms. Forrest at the conclusion of the visit and a copy was given to her. I appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 Kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 11/6/2023 Number Present: 124 Completed Date: 11/6/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 08:30 AM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced visit was conducted at this child care today to monitor compliance with all applicable childcare requirements. This visit was conducted with Ms. Deborah Forrest, Administrator. Ms. Forrest left in the afternoon at her usual scheduled time and allowed Ms. Tiffani Hannah to sign the report on her behalf. I reviewed the report with Ms. Forrest before she left. This program currently operates with a Five Star license. Restrictions include first and second shift, meets enhanced ratios, meets enhanced space. The license was posted and the restrictions were being followed. The NC Secretary of State website was reviewed on 08/20/2023. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit I observed children playing with toys, having circle time, eating lunch, taking a nap, playing indoors and outdoors and going home. The last annual compliance visit was conducted on 02/01/2023. The last sanitation inspection was conducted on 11/03/2023. The last fire inspection was conducted on 01/20/2023. A fire drill was documented on 10/30/2023. A shelter in place drill was documented on 08/31/2023. An outdoor inspection was documented on 10/27/2023. I observed program records and posted items today. I observed staff and children’s records today according to DCDEE procedures. I observed the storage of hazardous items and cleaning supplies. I observed both the storage of medications and the administration of medication paperwork. This program does not provide transportation. Ms. Forrest reports that there are no school age children enrolled at this program. I documented the following violations during today’s visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. There was no proof that the Summary of the Law was given to the parent of one child. GS 110-102 115 A summary of the NC Child Care Law was not posted in a prominent place in the center. G.S. 110-102 428 A current activity plan was not posted for each group of children for reference. The current lesson plan was not posted in space 6. GS 110-91(12); .0508(a) 432 The center did not have developmentally appropriate equipment and materials accessible daily. There were not three different toys available for play in the book areas in spaces 2, 3, 4, 12 and 10. This was corrected in all the spaces during the visit. There were not enough blocks for three children to play in the block centers in spaces 4 and 12. This was corrected during the visit. There were not three art activities available to children in space 4. This was corrected during the visit. There was no art activity area available to children ages two years and up in spaces 12 and 11. This was corrected in space 12 during the visit, but was not corrected in space 11. GS 110-91(12);10A NCAC 09 .0509(1) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator thermometer in space 4 showed the temperature of 50 degrees. Ms. Forrest threw the thermometer away and replaces it with a new one during the visit, which showed 40 degrees. 15A NCAC 18A .2806(j)(2) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets were not covered in space 12. 10A NCAC 09 .0604(c) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. There was not a first aid sheet posted for all staff to view. .0802(h) I have asked Ms. Forrest to send me written documentation by November 20, 2023 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. I provided the following Technical Assistance during today’s visit: I suggested that all papers that parents must see be posted in the main entrance hallway, instead of in each classroom, where the form may be taken off the wall. I suggested that all drills older than one year be disposed of to make more room in the notebook. Ms. Forrest and I discussed the pros and cons of child care centers and child care homes. I suggested that Ms. Forrest may want to have the staff who have complete activity centers in their classrooms help the classroom teachers where materials are lacking. I have told Ms. Forrest and staff that if a child cannot reach a toy or material or cannot open the lid without help, this does not count as accessible. I have given Ms. Forrest the contact information of a person who will teach CPR to even one person. I have told staff that they must record when a medication is given to a child each time it is given. I have talked to Ms. Forrest about transporting children. She stated that she will not take children on field trips if it is not a requirement. She stated that the center does not transport children to home or school. One staff person's doctor did not fill out her medical form properly. The staff person left the center and went to the doctor and had him fill it out properly, and brought the completed form back during the visit. I have talked to Ms. Forrest about the rated license and have made the educated guess that the rated license will not be reviewed again until 2027 at this site. Ms. Forrest stated that she has found it very difficult to find qualified staff. I have reviewed this visit summary with Ms. Hannah at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0509 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 11/6/2023 Number Present: 124 Completed Date: 11/6/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 08:30 AM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced visit was conducted at this child care today to monitor compliance with all applicable childcare requirements. This visit was conducted with Ms. Deborah Forrest, Administrator. Ms. Forrest left in the afternoon at her usual scheduled time and allowed Ms. Tiffani Hannah to sign the report on her behalf. I reviewed the report with Ms. Forrest before she left. This program currently operates with a Five Star license. Restrictions include first and second shift, meets enhanced ratios, meets enhanced space. The license was posted and the restrictions were being followed. The NC Secretary of State website was reviewed on 08/20/2023. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit I observed children playing with toys, having circle time, eating lunch, taking a nap, playing indoors and outdoors and going home. The last annual compliance visit was conducted on 02/01/2023. The last sanitation inspection was conducted on 11/03/2023. The last fire inspection was conducted on 01/20/2023. A fire drill was documented on 10/30/2023. A shelter in place drill was documented on 08/31/2023. An outdoor inspection was documented on 10/27/2023. I observed program records and posted items today. I observed staff and children’s records today according to DCDEE procedures. I observed the storage of hazardous items and cleaning supplies. I observed both the storage of medications and the administration of medication paperwork. This program does not provide transportation. Ms. Forrest reports that there are no school age children enrolled at this program. I documented the following violations during today’s visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. There was no proof that the Summary of the Law was given to the parent of one child. GS 110-102 115 A summary of the NC Child Care Law was not posted in a prominent place in the center. G.S. 110-102 428 A current activity plan was not posted for each group of children for reference. The current lesson plan was not posted in space 6. GS 110-91(12); .0508(a) 432 The center did not have developmentally appropriate equipment and materials accessible daily. There were not three different toys available for play in the book areas in spaces 2, 3, 4, 12 and 10. This was corrected in all the spaces during the visit. There were not enough blocks for three children to play in the block centers in spaces 4 and 12. This was corrected during the visit. There were not three art activities available to children in space 4. This was corrected during the visit. There was no art activity area available to children ages two years and up in spaces 12 and 11. This was corrected in space 12 during the visit, but was not corrected in space 11. GS 110-91(12);10A NCAC 09 .0509(1) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator thermometer in space 4 showed the temperature of 50 degrees. Ms. Forrest threw the thermometer away and replaces it with a new one during the visit, which showed 40 degrees. 15A NCAC 18A .2806(j)(2) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets were not covered in space 12. 10A NCAC 09 .0604(c) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. There was not a first aid sheet posted for all staff to view. .0802(h) I have asked Ms. Forrest to send me written documentation by November 20, 2023 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. I provided the following Technical Assistance during today’s visit: I suggested that all papers that parents must see be posted in the main entrance hallway, instead of in each classroom, where the form may be taken off the wall. I suggested that all drills older than one year be disposed of to make more room in the notebook. Ms. Forrest and I discussed the pros and cons of child care centers and child care homes. I suggested that Ms. Forrest may want to have the staff who have complete activity centers in their classrooms help the classroom teachers where materials are lacking. I have told Ms. Forrest and staff that if a child cannot reach a toy or material or cannot open the lid without help, this does not count as accessible. I have given Ms. Forrest the contact information of a person who will teach CPR to even one person. I have told staff that they must record when a medication is given to a child each time it is given. I have talked to Ms. Forrest about transporting children. She stated that she will not take children on field trips if it is not a requirement. She stated that the center does not transport children to home or school. One staff person's doctor did not fill out her medical form properly. The staff person left the center and went to the doctor and had him fill it out properly, and brought the completed form back during the visit. I have talked to Ms. Forrest about the rated license and have made the educated guess that the rated license will not be reviewed again until 2027 at this site. Ms. Forrest stated that she has found it very difficult to find qualified staff. I have reviewed this visit summary with Ms. Hannah at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-102 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 11/6/2023 Number Present: 124 Completed Date: 11/6/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 08:30 AM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced visit was conducted at this child care today to monitor compliance with all applicable childcare requirements. This visit was conducted with Ms. Deborah Forrest, Administrator. Ms. Forrest left in the afternoon at her usual scheduled time and allowed Ms. Tiffani Hannah to sign the report on her behalf. I reviewed the report with Ms. Forrest before she left. This program currently operates with a Five Star license. Restrictions include first and second shift, meets enhanced ratios, meets enhanced space. The license was posted and the restrictions were being followed. The NC Secretary of State website was reviewed on 08/20/2023. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit I observed children playing with toys, having circle time, eating lunch, taking a nap, playing indoors and outdoors and going home. The last annual compliance visit was conducted on 02/01/2023. The last sanitation inspection was conducted on 11/03/2023. The last fire inspection was conducted on 01/20/2023. A fire drill was documented on 10/30/2023. A shelter in place drill was documented on 08/31/2023. An outdoor inspection was documented on 10/27/2023. I observed program records and posted items today. I observed staff and children’s records today according to DCDEE procedures. I observed the storage of hazardous items and cleaning supplies. I observed both the storage of medications and the administration of medication paperwork. This program does not provide transportation. Ms. Forrest reports that there are no school age children enrolled at this program. I documented the following violations during today’s visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. There was no proof that the Summary of the Law was given to the parent of one child. GS 110-102 115 A summary of the NC Child Care Law was not posted in a prominent place in the center. G.S. 110-102 428 A current activity plan was not posted for each group of children for reference. The current lesson plan was not posted in space 6. GS 110-91(12); .0508(a) 432 The center did not have developmentally appropriate equipment and materials accessible daily. There were not three different toys available for play in the book areas in spaces 2, 3, 4, 12 and 10. This was corrected in all the spaces during the visit. There were not enough blocks for three children to play in the block centers in spaces 4 and 12. This was corrected during the visit. There were not three art activities available to children in space 4. This was corrected during the visit. There was no art activity area available to children ages two years and up in spaces 12 and 11. This was corrected in space 12 during the visit, but was not corrected in space 11. GS 110-91(12);10A NCAC 09 .0509(1) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator thermometer in space 4 showed the temperature of 50 degrees. Ms. Forrest threw the thermometer away and replaces it with a new one during the visit, which showed 40 degrees. 15A NCAC 18A .2806(j)(2) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets were not covered in space 12. 10A NCAC 09 .0604(c) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. There was not a first aid sheet posted for all staff to view. .0802(h) I have asked Ms. Forrest to send me written documentation by November 20, 2023 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. I provided the following Technical Assistance during today’s visit: I suggested that all papers that parents must see be posted in the main entrance hallway, instead of in each classroom, where the form may be taken off the wall. I suggested that all drills older than one year be disposed of to make more room in the notebook. Ms. Forrest and I discussed the pros and cons of child care centers and child care homes. I suggested that Ms. Forrest may want to have the staff who have complete activity centers in their classrooms help the classroom teachers where materials are lacking. I have told Ms. Forrest and staff that if a child cannot reach a toy or material or cannot open the lid without help, this does not count as accessible. I have given Ms. Forrest the contact information of a person who will teach CPR to even one person. I have told staff that they must record when a medication is given to a child each time it is given. I have talked to Ms. Forrest about transporting children. She stated that she will not take children on field trips if it is not a requirement. She stated that the center does not transport children to home or school. One staff person's doctor did not fill out her medical form properly. The staff person left the center and went to the doctor and had him fill it out properly, and brought the completed form back during the visit. I have talked to Ms. Forrest about the rated license and have made the educated guess that the rated license will not be reviewed again until 2027 at this site. Ms. Forrest stated that she has found it very difficult to find qualified staff. I have reviewed this visit summary with Ms. Hannah at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-102 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 11/6/2023 Number Present: 124 Completed Date: 11/6/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 08:30 AM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced visit was conducted at this child care today to monitor compliance with all applicable childcare requirements. This visit was conducted with Ms. Deborah Forrest, Administrator. Ms. Forrest left in the afternoon at her usual scheduled time and allowed Ms. Tiffani Hannah to sign the report on her behalf. I reviewed the report with Ms. Forrest before she left. This program currently operates with a Five Star license. Restrictions include first and second shift, meets enhanced ratios, meets enhanced space. The license was posted and the restrictions were being followed. The NC Secretary of State website was reviewed on 08/20/2023. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit I observed children playing with toys, having circle time, eating lunch, taking a nap, playing indoors and outdoors and going home. The last annual compliance visit was conducted on 02/01/2023. The last sanitation inspection was conducted on 11/03/2023. The last fire inspection was conducted on 01/20/2023. A fire drill was documented on 10/30/2023. A shelter in place drill was documented on 08/31/2023. An outdoor inspection was documented on 10/27/2023. I observed program records and posted items today. I observed staff and children’s records today according to DCDEE procedures. I observed the storage of hazardous items and cleaning supplies. I observed both the storage of medications and the administration of medication paperwork. This program does not provide transportation. Ms. Forrest reports that there are no school age children enrolled at this program. I documented the following violations during today’s visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. There was no proof that the Summary of the Law was given to the parent of one child. GS 110-102 115 A summary of the NC Child Care Law was not posted in a prominent place in the center. G.S. 110-102 428 A current activity plan was not posted for each group of children for reference. The current lesson plan was not posted in space 6. GS 110-91(12); .0508(a) 432 The center did not have developmentally appropriate equipment and materials accessible daily. There were not three different toys available for play in the book areas in spaces 2, 3, 4, 12 and 10. This was corrected in all the spaces during the visit. There were not enough blocks for three children to play in the block centers in spaces 4 and 12. This was corrected during the visit. There were not three art activities available to children in space 4. This was corrected during the visit. There was no art activity area available to children ages two years and up in spaces 12 and 11. This was corrected in space 12 during the visit, but was not corrected in space 11. GS 110-91(12);10A NCAC 09 .0509(1) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator thermometer in space 4 showed the temperature of 50 degrees. Ms. Forrest threw the thermometer away and replaces it with a new one during the visit, which showed 40 degrees. 15A NCAC 18A .2806(j)(2) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets were not covered in space 12. 10A NCAC 09 .0604(c) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. There was not a first aid sheet posted for all staff to view. .0802(h) I have asked Ms. Forrest to send me written documentation by November 20, 2023 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. I provided the following Technical Assistance during today’s visit: I suggested that all papers that parents must see be posted in the main entrance hallway, instead of in each classroom, where the form may be taken off the wall. I suggested that all drills older than one year be disposed of to make more room in the notebook. Ms. Forrest and I discussed the pros and cons of child care centers and child care homes. I suggested that Ms. Forrest may want to have the staff who have complete activity centers in their classrooms help the classroom teachers where materials are lacking. I have told Ms. Forrest and staff that if a child cannot reach a toy or material or cannot open the lid without help, this does not count as accessible. I have given Ms. Forrest the contact information of a person who will teach CPR to even one person. I have told staff that they must record when a medication is given to a child each time it is given. I have talked to Ms. Forrest about transporting children. She stated that she will not take children on field trips if it is not a requirement. She stated that the center does not transport children to home or school. One staff person's doctor did not fill out her medical form properly. The staff person left the center and went to the doctor and had him fill it out properly, and brought the completed form back during the visit. I have talked to Ms. Forrest about the rated license and have made the educated guess that the rated license will not be reviewed again until 2027 at this site. Ms. Forrest stated that she has found it very difficult to find qualified staff. I have reviewed this visit summary with Ms. Hannah at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: BETHLEHEM COMMUNITY CHILD DEVELOPMENT CENTER Facility ID: 3451073 Consultant: KELLY HEALY Operation Type: Center Case Number: Visit Date: 11/6/2023 Number Present: 124 Completed Date: 11/6/2023 Age: From 0 To 5 Total Minutes: 480 Time In: 08:30 AM Time Out: 04:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced visit was conducted at this child care today to monitor compliance with all applicable childcare requirements. This visit was conducted with Ms. Deborah Forrest, Administrator. Ms. Forrest left in the afternoon at her usual scheduled time and allowed Ms. Tiffani Hannah to sign the report on her behalf. I reviewed the report with Ms. Forrest before she left. This program currently operates with a Five Star license. Restrictions include first and second shift, meets enhanced ratios, meets enhanced space. The license was posted and the restrictions were being followed. The NC Secretary of State website was reviewed on 08/20/2023. The program’s compliance history was 90% prior to today’s visit. Programs are required to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. I have observed indoor and outdoor areas today. I monitored staff/child ratios and space capacity today, as is indicated on the attached worksheet. I observed proper supervision of children. During the visit I observed children playing with toys, having circle time, eating lunch, taking a nap, playing indoors and outdoors and going home. The last annual compliance visit was conducted on 02/01/2023. The last sanitation inspection was conducted on 11/03/2023. The last fire inspection was conducted on 01/20/2023. A fire drill was documented on 10/30/2023. A shelter in place drill was documented on 08/31/2023. An outdoor inspection was documented on 10/27/2023. I observed program records and posted items today. I observed staff and children’s records today according to DCDEE procedures. I observed the storage of hazardous items and cleaning supplies. I observed both the storage of medications and the administration of medication paperwork. This program does not provide transportation. Ms. Forrest reports that there are no school age children enrolled at this program. I documented the following violations during today’s visit: Violation Number Comment Rule 114 A summary of the NC Child Care Law was not given to a parent of every child enrolled in the center. There was no proof that the Summary of the Law was given to the parent of one child. GS 110-102 115 A summary of the NC Child Care Law was not posted in a prominent place in the center. G.S. 110-102 428 A current activity plan was not posted for each group of children for reference. The current lesson plan was not posted in space 6. GS 110-91(12); .0508(a) 432 The center did not have developmentally appropriate equipment and materials accessible daily. There were not three different toys available for play in the book areas in spaces 2, 3, 4, 12 and 10. This was corrected in all the spaces during the visit. There were not enough blocks for three children to play in the block centers in spaces 4 and 12. This was corrected during the visit. There were not three art activities available to children in space 4. This was corrected during the visit. There was no art activity area available to children ages two years and up in spaces 12 and 11. This was corrected in space 12 during the visit, but was not corrected in space 11. GS 110-91(12);10A NCAC 09 .0509(1) 601 Refrigerator(s) did not maintain a temperature of 45 degrees F. or below. The refrigerator thermometer in space 4 showed the temperature of 50 degrees. Ms. Forrest threw the thermometer away and replaces it with a new one during the visit, which showed 40 degrees. 15A NCAC 18A .2806(j)(2) 812 Electrical outlets and power strips, not in use, which were located in space used by children did not have safety outlets or were not covered with safety plugs unless located behind furniture or equipment that cannot be moved by a child. Electrical outlets were not covered in space 12. 10A NCAC 09 .0604(c) 830 A First Aid information sheet was not posted in a place for referral and/or the information sheet did not include all the required information. There was not a first aid sheet posted for all staff to view. .0802(h) I have asked Ms. Forrest to send me written documentation by November 20, 2023 indicating that the violations that were documented today have been corrected. I have asked her to include the center name and license number in her documentation, each violation number and how each was corrected, and to both sign and date the document. The document may be mailed or emailed to me at the address below. I have reminded Ms. Forrest that if the documentation indicates that corrections have been made when they have not, this may be considered falsification of information and an Administrative Action may be recommended. In addition, repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date indicated in this visit summary could lead to the recommendation of an Administrative Action. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. I provided the following Technical Assistance during today’s visit: I suggested that all papers that parents must see be posted in the main entrance hallway, instead of in each classroom, where the form may be taken off the wall. I suggested that all drills older than one year be disposed of to make more room in the notebook. Ms. Forrest and I discussed the pros and cons of child care centers and child care homes. I suggested that Ms. Forrest may want to have the staff who have complete activity centers in their classrooms help the classroom teachers where materials are lacking. I have told Ms. Forrest and staff that if a child cannot reach a toy or material or cannot open the lid without help, this does not count as accessible. I have given Ms. Forrest the contact information of a person who will teach CPR to even one person. I have told staff that they must record when a medication is given to a child each time it is given. I have talked to Ms. Forrest about transporting children. She stated that she will not take children on field trips if it is not a requirement. She stated that the center does not transport children to home or school. One staff person's doctor did not fill out her medical form properly. The staff person left the center and went to the doctor and had him fill it out properly, and brought the completed form back during the visit. I have talked to Ms. Forrest about the rated license and have made the educated guess that the rated license will not be reviewed again until 2027 at this site. Ms. Forrest stated that she has found it very difficult to find qualified staff. I have reviewed this visit summary with Ms. Hannah at the conclusion of the visit and a copy was given to her. I have appreciated Ms. Forrest’s time and assistance with this visit and have encouraged her to contact me if she has any questions at 336-317-5601. Kelly Healy PO Box 20423 Winston – Salem, NC 27120 kelly.healy@dhhs.nc.gov My supervisor, Ms. Pamela Hauser, can be reached at Pamela.Hauser@dhhs.nc.gov. For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times