Kimberley Park Extended DAY Program

10A NCAC 09 .0607 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/17/2026 Number Present: 38 Completed Date: 2/17/2026 Age: From 3 To 11 Total Minutes: 275 Time In: 12:25 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. Laquetta Williams, WSFCS Licensing Specialist, was present during the review of the visit summary. Your program currently operates with a 5- Star license. Restrictions include first shift care, School Age only, and meets all enhanced requirements plus reduced ratios minus one. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 83 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 12, 13, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 was not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, eating snack, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 2/27/2025. A sanitation inspection was completed 4/07/2025 with a Superior classification. The last fire inspection was conducted 3/07/2025; a copy of this inspection was provided to me during the visit. Program records and required postings were monitored. A fire drill was conducted on 1/23/2026. A lockdown drill was documented on 12/18/2025. An outdoor inspection was documented on 1/14/2026. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today and found to be in compliance. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. A copy of the incident reports completed for five children enrolled were not observed on file for review. .0802 (e) 1324 Signed and dated statement by parent that discipline policy received and explained at enrollment was not in child's file. A signed receipt of the facility’s Discipline Policy was not observed on file for review for seven children enrolled. .1804(c) 1739 All records required were not available for review by a representative of the Division. The file for one child enrolled was observed to be empty and did not contain any information. .2318(1-8) 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. A bottle of orange soda was observed on a staff desk in Room 13 in view and access of children enrolled. .0901(i) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The medical action plans for two children enrolled with emergency medications were not observed on file for review. .0801(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. A signed receipt of the Prevention of Shaken Baby and Abusive Head Trauma policy was not observed on file for review for the new staff member. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The medication authorization form for one child enrolled did not include a parent signature. The medication authorization form for one child enrolled with an emergency medication did not include a chronic medical or allergic condition. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. The training certificate for Recognizing and Responding to Suspicions of Child Abuse and Maltreatment was recorded as completed by a new staff member on 12/03/2025; the staff member’s start date was recorded as 6/16/2025. .1102(g) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. The file for one existing staff member did not contain a training certificate for Health and Safety Training Topic #4 (Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic) was not observed on file for review. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/03/2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 4948 Martin View Lane Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance documented during today’s visit: A copy of the incident reports completed for five children enrolled were not observed on file for review. Mrs. Leach stated she did not realize a copy of these reports had to be kept on file in addition to the incident log. The medical action plans for two children enrolled with emergency medications were not observed on file for review. The medication authorization form for one child enrolled did not include a parent signature. The medication authorization form for one child enrolled with an emergency medication did not include a chronic medical or allergic condition. A signed receipt of the facility’s Discipline Policy was not observed on file for review for seven children enrolled. The file for one child enrolled was observed to be empty and did not contain any information. The file for one existing staff member did not contain a training certificate for Health and Safety Training Topic #4 (Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic) was not observed on file for review. The training certificate for Recognizing and Responding to Suspicions of Child Abuse and Maltreatment was recorded as completed by a new staff member on 12/03/2025; the staff member’s start date was recorded as 6/16/2025. It is imperative that all required documentation be current, complete, and on file at all times for the health, safety, and quality of care of children enrolled. You may consider completing a file review for all child, staff, and program files, using Child Care Rule as a reference, to ensure all required forms are not only on file, but complete with accurate information. A bottle of orange soda was observed on a staff desk in Room 13. It is important for staff to model healthy eating habits for children enrolled. Teachers may consider using an opaque container with a lid to store any personal beverage other than water. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. The following Child Care Rules were reviewed with Ms. Williams during the visit: 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) regarding the annual review of the plan 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) 10A NCAC 09 .2508 AGE APPROPRIATE ACTIVITIES (c) regarding sufficient materials for children of School Age Add Mrs. Gwyn’s name to the Offsite Verification Form for Staff Records, and updated the information on the form to reflect the contact person at County Office who is responsible for maintaining these records. On-Going Professional Development In addition to the required Health and Safety Trainings, staff can access professional development training on the DCDEE website in Moodle under Early Childhood Professional Development in the categories of Child Care and Development Fund (CCDF), Orientation and Regulatory. Updated training modules are being added, including a Child Care Rule Rollout with new rules effective July 1, 2025, found under the Regulatory tab. Specifically, under the Orientation tab, I would encourage all staff to complete the training for “Child Development Module.” This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID username and password is needed to access the DCDEE Moodle. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2508 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/17/2026 Number Present: 38 Completed Date: 2/17/2026 Age: From 3 To 11 Total Minutes: 275 Time In: 12:25 PM Time Out: 05:00 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. Laquetta Williams, WSFCS Licensing Specialist, was present during the review of the visit summary. Your program currently operates with a 5- Star license. Restrictions include first shift care, School Age only, and meets all enhanced requirements plus reduced ratios minus one. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 83 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 12, 13, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 was not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, eating snack, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 2/27/2025. A sanitation inspection was completed 4/07/2025 with a Superior classification. The last fire inspection was conducted 3/07/2025; a copy of this inspection was provided to me during the visit. Program records and required postings were monitored. A fire drill was conducted on 1/23/2026. A lockdown drill was documented on 12/18/2025. An outdoor inspection was documented on 1/14/2026. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today and found to be in compliance. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 852 Incident reports were not completed each time a child was injured, it did not include all the information required in rule, it was not signed by the parent and/or it was not maintained in the child's file. A copy of the incident reports completed for five children enrolled were not observed on file for review. .0802 (e) 1324 Signed and dated statement by parent that discipline policy received and explained at enrollment was not in child's file. A signed receipt of the facility’s Discipline Policy was not observed on file for review for seven children enrolled. .1804(c) 1739 All records required were not available for review by a representative of the Division. The file for one child enrolled was observed to be empty and did not contain any information. .2318(1-8) 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. A bottle of orange soda was observed on a staff desk in Room 13 in view and access of children enrolled. .0901(i) 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The medical action plans for two children enrolled with emergency medications were not observed on file for review. .0801(b) 1874 The Prevention of Shaken Baby Syndrome and Abusive Head Trauma policy was not reviewed with new staff prior to providing care with children and/or a signed acknowledgement with all the required information was not maintained in the staff person's file. A signed receipt of the Prevention of Shaken Baby and Abusive Head Trauma policy was not observed on file for review for the new staff member. .0608(d)(1-4) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The medication authorization form for one child enrolled did not include a parent signature. The medication authorization form for one child enrolled with an emergency medication did not include a chronic medical or allergic condition. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1897 The child care administrator and all staff did not complete the Recognizing and Responding to Suspicions of Child Maltreatment training within 90 days of employment. The training certificate for Recognizing and Responding to Suspicions of Child Abuse and Maltreatment was recorded as completed by a new staff member on 12/03/2025; the staff member’s start date was recorded as 6/16/2025. .1102(g) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. The file for one existing staff member did not contain a training certificate for Health and Safety Training Topic #4 (Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic) was not observed on file for review. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/03/2026. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 4948 Martin View Lane Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance documented during today’s visit: A copy of the incident reports completed for five children enrolled were not observed on file for review. Mrs. Leach stated she did not realize a copy of these reports had to be kept on file in addition to the incident log. The medical action plans for two children enrolled with emergency medications were not observed on file for review. The medication authorization form for one child enrolled did not include a parent signature. The medication authorization form for one child enrolled with an emergency medication did not include a chronic medical or allergic condition. A signed receipt of the facility’s Discipline Policy was not observed on file for review for seven children enrolled. The file for one child enrolled was observed to be empty and did not contain any information. The file for one existing staff member did not contain a training certificate for Health and Safety Training Topic #4 (Building and physical premises safety, including identification of and protection from hazards that can cause bodily injury such as electrical hazards, bodies of water, and vehicular traffic) was not observed on file for review. The training certificate for Recognizing and Responding to Suspicions of Child Abuse and Maltreatment was recorded as completed by a new staff member on 12/03/2025; the staff member’s start date was recorded as 6/16/2025. It is imperative that all required documentation be current, complete, and on file at all times for the health, safety, and quality of care of children enrolled. You may consider completing a file review for all child, staff, and program files, using Child Care Rule as a reference, to ensure all required forms are not only on file, but complete with accurate information. A bottle of orange soda was observed on a staff desk in Room 13. It is important for staff to model healthy eating habits for children enrolled. Teachers may consider using an opaque container with a lid to store any personal beverage other than water. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. The following Child Care Rules were reviewed with Ms. Williams during the visit: 10A NCAC 09 .0607 EMERGENCY PREPAREDNESS AND RESPONSE IN CHILD CARE CENTERS (e) regarding the annual review of the plan 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) 10A NCAC 09 .2508 AGE APPROPRIATE ACTIVITIES (c) regarding sufficient materials for children of School Age Add Mrs. Gwyn’s name to the Offsite Verification Form for Staff Records, and updated the information on the form to reflect the contact person at County Office who is responsible for maintaining these records. On-Going Professional Development In addition to the required Health and Safety Trainings, staff can access professional development training on the DCDEE website in Moodle under Early Childhood Professional Development in the categories of Child Care and Development Fund (CCDF), Orientation and Regulatory. Updated training modules are being added, including a Child Care Rule Rollout with new rules effective July 1, 2025, found under the Regulatory tab. Specifically, under the Orientation tab, I would encourage all staff to complete the training for “Child Development Module.” This training module provides a basic overview about child development and is designed to help early educators support infants, toddlers, and preschool children to reach their next developmental milestone. In addition to gaining introductory knowledge about child development, early educators will learn about the many resources and professional agencies available in North Carolina to help with promoting a responsive and engaging learning environment to support all children served. Upon completion, participants will receive one (1) contact hour credit (CHC). An individual NCID username and password is needed to access the DCDEE Moodle. If you experience problems with Moodle, contact dcdee_moodle_support@dhhs.nc.gov for assistance. For other training-related questions, please contact the Training and Program Development Consultant, Amia Eaton by calling (919) 814-6365 or emailing her at Amia.Eaton@dhhs.nc.gov At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0713 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/27/2025 Number Present: 42 Completed Date: 2/27/2025 Age: From 3 To 11 Total Minutes: 310 Time In: 12:05 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. The purpose of today’s visit was to additionally review the results of your Environment Rating Scale (ERS) conducted on 1/23/2025 and to finalize your rated license assessment. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted in the visit summary. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 88 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 13, 37, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 and the cafeteria were not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 3/27/2024. A sanitation inspection was completed 4/24/2024 with a Superior classification. The last fire inspection was conducted 9/16/2024. Program records and required postings were monitored. A fire drill was conducted on 1/28/2025. A shelter in place drill was documented on 12/19/2024. An outdoor inspection was documented on 2/07/2025. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following items scoring less than a three on the ERS could constitute a violation of child care requirements and therefore, were monitored: SACERS-R assessment – January 23, 2025 – (M. Davis-Ivory; A. Miller) Total score – 5.95 Item 12 Indicator: 3.1 (see page 19 in the SACERS-R) Score: 2 pts Assessor Comments: The teacher reported that if children are sick, they may wait at the table near the entrance of the classrooms; this did not meet the requirements of this indicator because this classroom area is used by other children during the day. Observations Today: All children during today’s visit were observed to be healthy and able to be engaged in normal afterschool activities. Item 25 Indicator: 3.2 (see pages: 32 in the SACERS-R) Score: 2 pts Assessor Comments: The required use of science or nature books was not observed. Observations Today: Room 37 was not in use during today’s visit. I discussed with Ms. Leach strategies for increasing the scores of all items scoring less than a seven (7) and referenced the NCRLAP resource website: https://www.ncrlap.org/ - SACER-U for teachers to access further information. You are eligible for a new 5-Star License; this is based on the following: • Education: Points are earned based on the lowest level of education for any one position. The Administrator and Program Coordinator both meet 7 points in education. All Group Leaders meet 7 points in education. All Assistant Group Leaders meet 7 points in education. Based on the information noted above, your program earned 7 points in the Education component. • Program Standards: The program meets requirements in Rule .2806, enhanced ratios, and scoring a 5.0 or higher on the ERS. The ECERS was administered on 1/23/2025. The assessment report was reviewed during today’s visit. The scores are as follows: ECERS – 5.95. This facility will earn 5 points in this component. • Quality Point: Your center has a combined turnover rate of 20% or less for the administrator, program coordinator, lead teacher, teacher and group leader over the last 12 months (only applicable if the program has earned 4 point or higher in education). I have verified the education for each staff member in DCDEE Works; therefore, your program earned 1 Quality Point. • Total: 7 + 5 + 1 = 13 = 5 Star License. Upon approval from the DCDEE, a 5-Star license will be issued. The new license will be mailed directly to you and must be posted upon receipt. At that time, return the old license to me as it remains the property of the State of North Carolina. The following violations were cited during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. GS 110-91(12); .0508(a) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground. .2820(b) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. The emergency medication for one child enrolled in Room 11 (Space 1) was not stored in its original container. .0803(2)(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024. .0803(12) 1054 Documentation of staff's on-going training was not on file and/or was not current. The on-going training log was not observed on file for one existing staff member. 10A NCAC 09 .1106(a) 1756 Enhanced staff/child ratios and group sizes were not met. When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. 10A NCAC 09 .2818 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The emergency medication for one child enrolled in Room 11 (Space 1)did not have a medical action plan. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The emergency medication for one child enrolled in Room 11 (Space 1) did not have a medication authorization form. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files. .0701(d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/13/2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor staff: child ratio requirements. Technical assistance documented during today’s visit: • Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). Each of these canisters was disposed of during the visit. In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground; this sanitizer was placed greater than five feet from the ground during the visit. • The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files; these forms were removed from each personnel file during the visit and were placed into separate files. • When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. I asked if another staff member would be caring for the children with the existing staff member, and another staff member arrived in the classroom within five minutes. • The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024, was not stored in its original container, and did not have a medical action plan or medication authorization form. The emergency medication for another child enrolled in Room 11 (Space 1) did not have a medical action plan or medication authorization form. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. The on-going training log was not observed on file for one existing staff member. It is imperative for all required documentation to be posted and/or completed, current, and on file to ensure the health, safety, and quality of care of children enrolled. You may consider reviewing all medication and associated required documentation when the parent drops it off to ensure it is current, accurate, and complete prior to accepting it. You may also consider creating a routine system for ensuring all required documentation is posted for the new month at the end of the prior month. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rules were reviewed with Ms. Leach during the visit: • 15A NCAC 18A .2820 STORAGE (b) regarding locked storage for items labeled Keep Out of Reach of Children with additional warnings • § 110-99. Possession and display of license. (a1) regarding display of license • 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (10) regarding posted staff: child ratio worksheets • 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) The education for Ms. Nicole Paul, current Assistant Group Leader in Space 1 (Room 11), is not currently entered into DCDEE Works. The education for Ms. Mechelle Ivory-Davis, current Group Leader in Space 2 (Room 13) is also not currently in Works. The BSAC certification for Ms. T. Phillips and Ms. A. Miller has not been submitted to DCDEE Works. Each staff member will need to either create a WORKS account, and/or submit her education/ certification for evaluation. Once this education has been evaluated by DCDEE Works and I receive your Compliance Letter, I will finalize and submit your Rated License packet to the Raleigh office for the issuance of your new permit. You may consider conducting an inspection of Room 37 and the cafeteria prior to allowing children to use this space each day. Because these spaces have multiple uses, this will give you an opportunity to lock up or make inaccessible any potentially hazardous items. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February, 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401, and someone will assist you. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1106 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/27/2025 Number Present: 42 Completed Date: 2/27/2025 Age: From 3 To 11 Total Minutes: 310 Time In: 12:05 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. The purpose of today’s visit was to additionally review the results of your Environment Rating Scale (ERS) conducted on 1/23/2025 and to finalize your rated license assessment. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted in the visit summary. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 88 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 13, 37, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 and the cafeteria were not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 3/27/2024. A sanitation inspection was completed 4/24/2024 with a Superior classification. The last fire inspection was conducted 9/16/2024. Program records and required postings were monitored. A fire drill was conducted on 1/28/2025. A shelter in place drill was documented on 12/19/2024. An outdoor inspection was documented on 2/07/2025. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following items scoring less than a three on the ERS could constitute a violation of child care requirements and therefore, were monitored: SACERS-R assessment – January 23, 2025 – (M. Davis-Ivory; A. Miller) Total score – 5.95 Item 12 Indicator: 3.1 (see page 19 in the SACERS-R) Score: 2 pts Assessor Comments: The teacher reported that if children are sick, they may wait at the table near the entrance of the classrooms; this did not meet the requirements of this indicator because this classroom area is used by other children during the day. Observations Today: All children during today’s visit were observed to be healthy and able to be engaged in normal afterschool activities. Item 25 Indicator: 3.2 (see pages: 32 in the SACERS-R) Score: 2 pts Assessor Comments: The required use of science or nature books was not observed. Observations Today: Room 37 was not in use during today’s visit. I discussed with Ms. Leach strategies for increasing the scores of all items scoring less than a seven (7) and referenced the NCRLAP resource website: https://www.ncrlap.org/ - SACER-U for teachers to access further information. You are eligible for a new 5-Star License; this is based on the following: • Education: Points are earned based on the lowest level of education for any one position. The Administrator and Program Coordinator both meet 7 points in education. All Group Leaders meet 7 points in education. All Assistant Group Leaders meet 7 points in education. Based on the information noted above, your program earned 7 points in the Education component. • Program Standards: The program meets requirements in Rule .2806, enhanced ratios, and scoring a 5.0 or higher on the ERS. The ECERS was administered on 1/23/2025. The assessment report was reviewed during today’s visit. The scores are as follows: ECERS – 5.95. This facility will earn 5 points in this component. • Quality Point: Your center has a combined turnover rate of 20% or less for the administrator, program coordinator, lead teacher, teacher and group leader over the last 12 months (only applicable if the program has earned 4 point or higher in education). I have verified the education for each staff member in DCDEE Works; therefore, your program earned 1 Quality Point. • Total: 7 + 5 + 1 = 13 = 5 Star License. Upon approval from the DCDEE, a 5-Star license will be issued. The new license will be mailed directly to you and must be posted upon receipt. At that time, return the old license to me as it remains the property of the State of North Carolina. The following violations were cited during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. GS 110-91(12); .0508(a) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground. .2820(b) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. The emergency medication for one child enrolled in Room 11 (Space 1) was not stored in its original container. .0803(2)(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024. .0803(12) 1054 Documentation of staff's on-going training was not on file and/or was not current. The on-going training log was not observed on file for one existing staff member. 10A NCAC 09 .1106(a) 1756 Enhanced staff/child ratios and group sizes were not met. When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. 10A NCAC 09 .2818 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The emergency medication for one child enrolled in Room 11 (Space 1)did not have a medical action plan. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The emergency medication for one child enrolled in Room 11 (Space 1) did not have a medication authorization form. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files. .0701(d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/13/2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor staff: child ratio requirements. Technical assistance documented during today’s visit: • Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). Each of these canisters was disposed of during the visit. In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground; this sanitizer was placed greater than five feet from the ground during the visit. • The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files; these forms were removed from each personnel file during the visit and were placed into separate files. • When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. I asked if another staff member would be caring for the children with the existing staff member, and another staff member arrived in the classroom within five minutes. • The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024, was not stored in its original container, and did not have a medical action plan or medication authorization form. The emergency medication for another child enrolled in Room 11 (Space 1) did not have a medical action plan or medication authorization form. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. The on-going training log was not observed on file for one existing staff member. It is imperative for all required documentation to be posted and/or completed, current, and on file to ensure the health, safety, and quality of care of children enrolled. You may consider reviewing all medication and associated required documentation when the parent drops it off to ensure it is current, accurate, and complete prior to accepting it. You may also consider creating a routine system for ensuring all required documentation is posted for the new month at the end of the prior month. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rules were reviewed with Ms. Leach during the visit: • 15A NCAC 18A .2820 STORAGE (b) regarding locked storage for items labeled Keep Out of Reach of Children with additional warnings • § 110-99. Possession and display of license. (a1) regarding display of license • 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (10) regarding posted staff: child ratio worksheets • 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) The education for Ms. Nicole Paul, current Assistant Group Leader in Space 1 (Room 11), is not currently entered into DCDEE Works. The education for Ms. Mechelle Ivory-Davis, current Group Leader in Space 2 (Room 13) is also not currently in Works. The BSAC certification for Ms. T. Phillips and Ms. A. Miller has not been submitted to DCDEE Works. Each staff member will need to either create a WORKS account, and/or submit her education/ certification for evaluation. Once this education has been evaluated by DCDEE Works and I receive your Compliance Letter, I will finalize and submit your Rated License packet to the Raleigh office for the issuance of your new permit. You may consider conducting an inspection of Room 37 and the cafeteria prior to allowing children to use this space each day. Because these spaces have multiple uses, this will give you an opportunity to lock up or make inaccessible any potentially hazardous items. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February, 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401, and someone will assist you. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2818 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/27/2025 Number Present: 42 Completed Date: 2/27/2025 Age: From 3 To 11 Total Minutes: 310 Time In: 12:05 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. The purpose of today’s visit was to additionally review the results of your Environment Rating Scale (ERS) conducted on 1/23/2025 and to finalize your rated license assessment. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted in the visit summary. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 88 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 13, 37, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 and the cafeteria were not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 3/27/2024. A sanitation inspection was completed 4/24/2024 with a Superior classification. The last fire inspection was conducted 9/16/2024. Program records and required postings were monitored. A fire drill was conducted on 1/28/2025. A shelter in place drill was documented on 12/19/2024. An outdoor inspection was documented on 2/07/2025. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following items scoring less than a three on the ERS could constitute a violation of child care requirements and therefore, were monitored: SACERS-R assessment – January 23, 2025 – (M. Davis-Ivory; A. Miller) Total score – 5.95 Item 12 Indicator: 3.1 (see page 19 in the SACERS-R) Score: 2 pts Assessor Comments: The teacher reported that if children are sick, they may wait at the table near the entrance of the classrooms; this did not meet the requirements of this indicator because this classroom area is used by other children during the day. Observations Today: All children during today’s visit were observed to be healthy and able to be engaged in normal afterschool activities. Item 25 Indicator: 3.2 (see pages: 32 in the SACERS-R) Score: 2 pts Assessor Comments: The required use of science or nature books was not observed. Observations Today: Room 37 was not in use during today’s visit. I discussed with Ms. Leach strategies for increasing the scores of all items scoring less than a seven (7) and referenced the NCRLAP resource website: https://www.ncrlap.org/ - SACER-U for teachers to access further information. You are eligible for a new 5-Star License; this is based on the following: • Education: Points are earned based on the lowest level of education for any one position. The Administrator and Program Coordinator both meet 7 points in education. All Group Leaders meet 7 points in education. All Assistant Group Leaders meet 7 points in education. Based on the information noted above, your program earned 7 points in the Education component. • Program Standards: The program meets requirements in Rule .2806, enhanced ratios, and scoring a 5.0 or higher on the ERS. The ECERS was administered on 1/23/2025. The assessment report was reviewed during today’s visit. The scores are as follows: ECERS – 5.95. This facility will earn 5 points in this component. • Quality Point: Your center has a combined turnover rate of 20% or less for the administrator, program coordinator, lead teacher, teacher and group leader over the last 12 months (only applicable if the program has earned 4 point or higher in education). I have verified the education for each staff member in DCDEE Works; therefore, your program earned 1 Quality Point. • Total: 7 + 5 + 1 = 13 = 5 Star License. Upon approval from the DCDEE, a 5-Star license will be issued. The new license will be mailed directly to you and must be posted upon receipt. At that time, return the old license to me as it remains the property of the State of North Carolina. The following violations were cited during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. GS 110-91(12); .0508(a) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground. .2820(b) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. The emergency medication for one child enrolled in Room 11 (Space 1) was not stored in its original container. .0803(2)(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024. .0803(12) 1054 Documentation of staff's on-going training was not on file and/or was not current. The on-going training log was not observed on file for one existing staff member. 10A NCAC 09 .1106(a) 1756 Enhanced staff/child ratios and group sizes were not met. When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. 10A NCAC 09 .2818 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The emergency medication for one child enrolled in Room 11 (Space 1)did not have a medical action plan. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The emergency medication for one child enrolled in Room 11 (Space 1) did not have a medication authorization form. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files. .0701(d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/13/2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor staff: child ratio requirements. Technical assistance documented during today’s visit: • Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). Each of these canisters was disposed of during the visit. In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground; this sanitizer was placed greater than five feet from the ground during the visit. • The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files; these forms were removed from each personnel file during the visit and were placed into separate files. • When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. I asked if another staff member would be caring for the children with the existing staff member, and another staff member arrived in the classroom within five minutes. • The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024, was not stored in its original container, and did not have a medical action plan or medication authorization form. The emergency medication for another child enrolled in Room 11 (Space 1) did not have a medical action plan or medication authorization form. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. The on-going training log was not observed on file for one existing staff member. It is imperative for all required documentation to be posted and/or completed, current, and on file to ensure the health, safety, and quality of care of children enrolled. You may consider reviewing all medication and associated required documentation when the parent drops it off to ensure it is current, accurate, and complete prior to accepting it. You may also consider creating a routine system for ensuring all required documentation is posted for the new month at the end of the prior month. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rules were reviewed with Ms. Leach during the visit: • 15A NCAC 18A .2820 STORAGE (b) regarding locked storage for items labeled Keep Out of Reach of Children with additional warnings • § 110-99. Possession and display of license. (a1) regarding display of license • 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (10) regarding posted staff: child ratio worksheets • 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) The education for Ms. Nicole Paul, current Assistant Group Leader in Space 1 (Room 11), is not currently entered into DCDEE Works. The education for Ms. Mechelle Ivory-Davis, current Group Leader in Space 2 (Room 13) is also not currently in Works. The BSAC certification for Ms. T. Phillips and Ms. A. Miller has not been submitted to DCDEE Works. Each staff member will need to either create a WORKS account, and/or submit her education/ certification for evaluation. Once this education has been evaluated by DCDEE Works and I receive your Compliance Letter, I will finalize and submit your Rated License packet to the Raleigh office for the issuance of your new permit. You may consider conducting an inspection of Room 37 and the cafeteria prior to allowing children to use this space each day. Because these spaces have multiple uses, this will give you an opportunity to lock up or make inaccessible any potentially hazardous items. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February, 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401, and someone will assist you. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-99 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/27/2025 Number Present: 42 Completed Date: 2/27/2025 Age: From 3 To 11 Total Minutes: 310 Time In: 12:05 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. The purpose of today’s visit was to additionally review the results of your Environment Rating Scale (ERS) conducted on 1/23/2025 and to finalize your rated license assessment. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted in the visit summary. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 88 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 13, 37, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 and the cafeteria were not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 3/27/2024. A sanitation inspection was completed 4/24/2024 with a Superior classification. The last fire inspection was conducted 9/16/2024. Program records and required postings were monitored. A fire drill was conducted on 1/28/2025. A shelter in place drill was documented on 12/19/2024. An outdoor inspection was documented on 2/07/2025. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following items scoring less than a three on the ERS could constitute a violation of child care requirements and therefore, were monitored: SACERS-R assessment – January 23, 2025 – (M. Davis-Ivory; A. Miller) Total score – 5.95 Item 12 Indicator: 3.1 (see page 19 in the SACERS-R) Score: 2 pts Assessor Comments: The teacher reported that if children are sick, they may wait at the table near the entrance of the classrooms; this did not meet the requirements of this indicator because this classroom area is used by other children during the day. Observations Today: All children during today’s visit were observed to be healthy and able to be engaged in normal afterschool activities. Item 25 Indicator: 3.2 (see pages: 32 in the SACERS-R) Score: 2 pts Assessor Comments: The required use of science or nature books was not observed. Observations Today: Room 37 was not in use during today’s visit. I discussed with Ms. Leach strategies for increasing the scores of all items scoring less than a seven (7) and referenced the NCRLAP resource website: https://www.ncrlap.org/ - SACER-U for teachers to access further information. You are eligible for a new 5-Star License; this is based on the following: • Education: Points are earned based on the lowest level of education for any one position. The Administrator and Program Coordinator both meet 7 points in education. All Group Leaders meet 7 points in education. All Assistant Group Leaders meet 7 points in education. Based on the information noted above, your program earned 7 points in the Education component. • Program Standards: The program meets requirements in Rule .2806, enhanced ratios, and scoring a 5.0 or higher on the ERS. The ECERS was administered on 1/23/2025. The assessment report was reviewed during today’s visit. The scores are as follows: ECERS – 5.95. This facility will earn 5 points in this component. • Quality Point: Your center has a combined turnover rate of 20% or less for the administrator, program coordinator, lead teacher, teacher and group leader over the last 12 months (only applicable if the program has earned 4 point or higher in education). I have verified the education for each staff member in DCDEE Works; therefore, your program earned 1 Quality Point. • Total: 7 + 5 + 1 = 13 = 5 Star License. Upon approval from the DCDEE, a 5-Star license will be issued. The new license will be mailed directly to you and must be posted upon receipt. At that time, return the old license to me as it remains the property of the State of North Carolina. The following violations were cited during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. GS 110-91(12); .0508(a) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground. .2820(b) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. The emergency medication for one child enrolled in Room 11 (Space 1) was not stored in its original container. .0803(2)(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024. .0803(12) 1054 Documentation of staff's on-going training was not on file and/or was not current. The on-going training log was not observed on file for one existing staff member. 10A NCAC 09 .1106(a) 1756 Enhanced staff/child ratios and group sizes were not met. When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. 10A NCAC 09 .2818 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The emergency medication for one child enrolled in Room 11 (Space 1)did not have a medical action plan. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The emergency medication for one child enrolled in Room 11 (Space 1) did not have a medication authorization form. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files. .0701(d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/13/2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor staff: child ratio requirements. Technical assistance documented during today’s visit: • Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). Each of these canisters was disposed of during the visit. In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground; this sanitizer was placed greater than five feet from the ground during the visit. • The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files; these forms were removed from each personnel file during the visit and were placed into separate files. • When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. I asked if another staff member would be caring for the children with the existing staff member, and another staff member arrived in the classroom within five minutes. • The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024, was not stored in its original container, and did not have a medical action plan or medication authorization form. The emergency medication for another child enrolled in Room 11 (Space 1) did not have a medical action plan or medication authorization form. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. The on-going training log was not observed on file for one existing staff member. It is imperative for all required documentation to be posted and/or completed, current, and on file to ensure the health, safety, and quality of care of children enrolled. You may consider reviewing all medication and associated required documentation when the parent drops it off to ensure it is current, accurate, and complete prior to accepting it. You may also consider creating a routine system for ensuring all required documentation is posted for the new month at the end of the prior month. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rules were reviewed with Ms. Leach during the visit: • 15A NCAC 18A .2820 STORAGE (b) regarding locked storage for items labeled Keep Out of Reach of Children with additional warnings • § 110-99. Possession and display of license. (a1) regarding display of license • 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (10) regarding posted staff: child ratio worksheets • 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) The education for Ms. Nicole Paul, current Assistant Group Leader in Space 1 (Room 11), is not currently entered into DCDEE Works. The education for Ms. Mechelle Ivory-Davis, current Group Leader in Space 2 (Room 13) is also not currently in Works. The BSAC certification for Ms. T. Phillips and Ms. A. Miller has not been submitted to DCDEE Works. Each staff member will need to either create a WORKS account, and/or submit her education/ certification for evaluation. Once this education has been evaluated by DCDEE Works and I receive your Compliance Letter, I will finalize and submit your Rated License packet to the Raleigh office for the issuance of your new permit. You may consider conducting an inspection of Room 37 and the cafeteria prior to allowing children to use this space each day. Because these spaces have multiple uses, this will give you an opportunity to lock up or make inaccessible any potentially hazardous items. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February, 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401, and someone will assist you. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 2/27/2025 Number Present: 42 Completed Date: 2/27/2025 Age: From 3 To 11 Total Minutes: 310 Time In: 12:05 PM Time Out: 05:15 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Sharon Leach, Lead Teacher. Diamond Gwyn, Principal, was also present during the visit. The purpose of today’s visit was to additionally review the results of your Environment Rating Scale (ERS) conducted on 1/23/2025 and to finalize your rated license assessment. ERS summaries were reviewed today and items scoring less than a three could constitute a violation of child care requirements and therefore were monitored. These items are noted in the visit summary. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 88 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. The facility currently uses Rooms 11, 13, 37, 38 and the cafeteria as licensed spaces for School Age care; the gym is approved as an auxiliary space. During today’s visit, Room 37 and the cafeteria were not in use. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children engaging in activities, conversations with their teachers, participating in general routines, and completing homework during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 3/27/2024. A sanitation inspection was completed 4/24/2024 with a Superior classification. The last fire inspection was conducted 9/16/2024. Program records and required postings were monitored. A fire drill was conducted on 1/28/2025. A shelter in place drill was documented on 12/19/2024. An outdoor inspection was documented on 2/07/2025. Staff files and children’s records were monitored per DCDEE procedures. The file for one new staff member and one existing staff member were monitored during the visit. The files for seven children enrolled were monitored during the visit as well. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored The program does not provide transportation, participate in off-premise activities, or participate in aquatic activities at this time. The following items scoring less than a three on the ERS could constitute a violation of child care requirements and therefore, were monitored: SACERS-R assessment – January 23, 2025 – (M. Davis-Ivory; A. Miller) Total score – 5.95 Item 12 Indicator: 3.1 (see page 19 in the SACERS-R) Score: 2 pts Assessor Comments: The teacher reported that if children are sick, they may wait at the table near the entrance of the classrooms; this did not meet the requirements of this indicator because this classroom area is used by other children during the day. Observations Today: All children during today’s visit were observed to be healthy and able to be engaged in normal afterschool activities. Item 25 Indicator: 3.2 (see pages: 32 in the SACERS-R) Score: 2 pts Assessor Comments: The required use of science or nature books was not observed. Observations Today: Room 37 was not in use during today’s visit. I discussed with Ms. Leach strategies for increasing the scores of all items scoring less than a seven (7) and referenced the NCRLAP resource website: https://www.ncrlap.org/ - SACER-U for teachers to access further information. You are eligible for a new 5-Star License; this is based on the following: • Education: Points are earned based on the lowest level of education for any one position. The Administrator and Program Coordinator both meet 7 points in education. All Group Leaders meet 7 points in education. All Assistant Group Leaders meet 7 points in education. Based on the information noted above, your program earned 7 points in the Education component. • Program Standards: The program meets requirements in Rule .2806, enhanced ratios, and scoring a 5.0 or higher on the ERS. The ECERS was administered on 1/23/2025. The assessment report was reviewed during today’s visit. The scores are as follows: ECERS – 5.95. This facility will earn 5 points in this component. • Quality Point: Your center has a combined turnover rate of 20% or less for the administrator, program coordinator, lead teacher, teacher and group leader over the last 12 months (only applicable if the program has earned 4 point or higher in education). I have verified the education for each staff member in DCDEE Works; therefore, your program earned 1 Quality Point. • Total: 7 + 5 + 1 = 13 = 5 Star License. Upon approval from the DCDEE, a 5-Star license will be issued. The new license will be mailed directly to you and must be posted upon receipt. At that time, return the old license to me as it remains the property of the State of North Carolina. The following violations were cited during today’s visit: Violation Number Comment Rule 102 The license was not posted in a prominent place at all times. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). G.S. 110-99(a1) 428 A current activity plan was not posted for each group of children for reference. The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. GS 110-91(12); .0508(a) 840 All corrosive agents, pesticides, bleaches, detergents, cleansers, polishes, any product which is under pressure in an aerosol dispenser, and any substance which may be hazardous to a child if ingested, inhaled, or handled were not stored in a locked room or cabinet. Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground. .2820(b) 844 Prescribed medicine was not in original labeled container or accompanied by signed and dated written instructions from prescribing physician or health care professional. The emergency medication for one child enrolled in Room 11 (Space 1) was not stored in its original container. .0803(2)(a) 849 Leftover medicines were not returned to the parent after the course of treatment was completed, after authorization was withdrawn or after authorization had expired and/or medication was not discarded within 72 hours of completion of treatment or withdrawal of authorization. The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024. .0803(12) 1054 Documentation of staff's on-going training was not on file and/or was not current. The on-going training log was not observed on file for one existing staff member. 10A NCAC 09 .1106(a) 1756 Enhanced staff/child ratios and group sizes were not met. When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. 10A NCAC 09 .2818 1834 Application did not have a medical action plan attached for any child with health care needs such as allergies, asthma, or other chronic conditions that require specialized health services. The emergency medication for one child enrolled in Room 11 (Space 1)did not have a medical action plan. .0801(b) 1882 Medication authorization, giving the caregiver standing authorization did not meet the specifications in rule. The emergency medication for one child enrolled in Room 11 (Space 1) did not have a medication authorization form. .0803(6)(a-i); .0803(7)(a-g); .0803(8)(a-d) 1890 Each staff member did not have the required medical report, proof of tuberculosis test or screening and/or completed health questionnaire in a medical file, maintained separately from the staff member's individual personnel file. The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files. .0701(d) 1899 Health and safety training topics were not included as part of on-going training within five years of completing the previous health and safety training topics. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. .1103(b) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 3/13/2025. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor staff: child ratio requirements. Technical assistance documented during today’s visit: • Three canisters of hand sanitizing wipes labeled Keep Out of Reach of Children with additional warnings were observed stored greater than five feet from the ground in a bathroom used by children in Room 13 (Space 2). Each of these canisters was disposed of during the visit. In Room 38 (Space 4), one large pump bottle of hand sanitizer was observed stored less than five feet from the ground; this sanitizer was placed greater than five feet from the ground during the visit. • The health questionnaires for one new staff member and one existing staff member were not stored separately from the staff members’ personnel files; these forms were removed from each personnel file during the visit and were placed into separate files. • When I entered Room 13 (Space 2) to monitor required postings, one staff member was observed in the classroom with eighteen (18) children five and six years of age. I asked if another staff member would be caring for the children with the existing staff member, and another staff member arrived in the classroom within five minutes. • The activity plan in Room 13 (Space 2) was observed to be dated 2/2/25 through 2/6/25. A copy of the program’s license was not posted in a prominent place in Room 38 (Space 4). The emergency medication for one child enrolled in Room 11 (Space 1) was observed to have expired in 10/2024, was not stored in its original container, and did not have a medical action plan or medication authorization form. The emergency medication for another child enrolled in Room 11 (Space 1) did not have a medical action plan or medication authorization form. Health and Safety training topic (2) Administration of medication, with standards for parental consent, was not observed on file for one existing staff member. The on-going training log was not observed on file for one existing staff member. It is imperative for all required documentation to be posted and/or completed, current, and on file to ensure the health, safety, and quality of care of children enrolled. You may consider reviewing all medication and associated required documentation when the parent drops it off to ensure it is current, accurate, and complete prior to accepting it. You may also consider creating a routine system for ensuring all required documentation is posted for the new month at the end of the prior month. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rules were reviewed with Ms. Leach during the visit: • 15A NCAC 18A .2820 STORAGE (b) regarding locked storage for items labeled Keep Out of Reach of Children with additional warnings • § 110-99. Possession and display of license. (a1) regarding display of license • 10A NCAC 09 .0713 STAFF/CHILD RATIOS FOR CENTERS (a) (10) regarding posted staff: child ratio worksheets • 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) The education for Ms. Nicole Paul, current Assistant Group Leader in Space 1 (Room 11), is not currently entered into DCDEE Works. The education for Ms. Mechelle Ivory-Davis, current Group Leader in Space 2 (Room 13) is also not currently in Works. The BSAC certification for Ms. T. Phillips and Ms. A. Miller has not been submitted to DCDEE Works. Each staff member will need to either create a WORKS account, and/or submit her education/ certification for evaluation. Once this education has been evaluated by DCDEE Works and I receive your Compliance Letter, I will finalize and submit your Rated License packet to the Raleigh office for the issuance of your new permit. You may consider conducting an inspection of Room 37 and the cafeteria prior to allowing children to use this space each day. Because these spaces have multiple uses, this will give you an opportunity to lock up or make inaccessible any potentially hazardous items. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February, 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS on an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401, and someone will assist you. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0604 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 11/25/2024 Number Present: 53 Completed Date: 11/25/2024 Age: From 3 To 11 Total Minutes: 225 Time In: 01:45 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for a routine unannounced visit. This visit was conducted by Cara McKeown-Stewart, Childcare Consultant with Sharon Leach, Lead Teacher and Diamond Gwyn, Principal. Your program currently operates with a 4-Star license effective 4/08/2022. Restrictions include 1st shift care and meets enhanced ratios. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • CPR / First Aid • Special Training • CBC Qualification • ITS – SIDS • Emergency Medical Care Plan • Administration of Medication • Storage of Hazardous Products • Storage of Medication • General Safety • Discipline • Adequate / Approved Space • Program Records • License Posted • Permit Restrictions The license was observed, and the restrictions monitored. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children playing with toys, engaging in conversations and activities with their teachers, eating snack, and participating in general routines during the visit. One new staff members was reported at this program; one substitute staff member was present with the children in the cafeteria during the visit. The file for this staff member was reviewed. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Recognizing and Responding to Suspicions of Child Abuse and Maltreatment, Special Trainings, and Criminal Background Checks. Storage and administration of medication and medication authorization were monitored. Storage of hazardous items was monitored today. A playground inspection was recorded 10/09/2024. A fire drill was recorded 10/31/2024. A lockdown drill for the facility was recorded 10/02/2024. The most recent fire inspection was on 9/16/2024. I observed a sanitation inspection was last conducted on 4/24/2024 earning a Superior classification. The program does not participate in transportation, off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 209 Children used space that was not approved. An unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. GS 110-91(1)&(4-5) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. .0713(a)(10), (c) & (f)(3); .2818(e) 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. An outlet was observed without a safety cover in Space 13. 10A NCAC 09 .0604(c) 847 Parent's medication authorization did not include required information. The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. 10A NCAC 09 .0803(4)(6-9) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 12/09/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor requirements for adequate and approved space. Technical assistance discussed during today’s visit: • The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. It is imperative that all required records are current and complete at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all medication records and required postings. • Consultation was given to teachers and administration during the Annual Compliance visit conducted on 3/27/2024 regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. This unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. Ms. Gwynn and I discussed potentially using the currently licensed Space 27 for School Age care. Ms. Gwynn stated the school is currently over-enrolled, and finding extra space to utilize, even during time after school, has been challenging. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Gwynn stated she will be considering options for a resolution. An outlet was observed without a safety cover in Space 13; a safety cover was placed in this outlet during the visit. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rule was discussed with Ms. Gwynn during a review of the visit: • 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) - 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. At the completion of the visit, this visit summary was printed and left for Ms. Gwyn to review. I stated I would contact Ms. Gwyn the following day to schedule a time to review this visit via phone. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown-Stewart, Child Care Consultant (336) 408-4849 cara.mckeown-stewart@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0508 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 11/25/2024 Number Present: 53 Completed Date: 11/25/2024 Age: From 3 To 11 Total Minutes: 225 Time In: 01:45 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for a routine unannounced visit. This visit was conducted by Cara McKeown-Stewart, Childcare Consultant with Sharon Leach, Lead Teacher and Diamond Gwyn, Principal. Your program currently operates with a 4-Star license effective 4/08/2022. Restrictions include 1st shift care and meets enhanced ratios. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • CPR / First Aid • Special Training • CBC Qualification • ITS – SIDS • Emergency Medical Care Plan • Administration of Medication • Storage of Hazardous Products • Storage of Medication • General Safety • Discipline • Adequate / Approved Space • Program Records • License Posted • Permit Restrictions The license was observed, and the restrictions monitored. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children playing with toys, engaging in conversations and activities with their teachers, eating snack, and participating in general routines during the visit. One new staff members was reported at this program; one substitute staff member was present with the children in the cafeteria during the visit. The file for this staff member was reviewed. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Recognizing and Responding to Suspicions of Child Abuse and Maltreatment, Special Trainings, and Criminal Background Checks. Storage and administration of medication and medication authorization were monitored. Storage of hazardous items was monitored today. A playground inspection was recorded 10/09/2024. A fire drill was recorded 10/31/2024. A lockdown drill for the facility was recorded 10/02/2024. The most recent fire inspection was on 9/16/2024. I observed a sanitation inspection was last conducted on 4/24/2024 earning a Superior classification. The program does not participate in transportation, off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 209 Children used space that was not approved. An unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. GS 110-91(1)&(4-5) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. .0713(a)(10), (c) & (f)(3); .2818(e) 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. An outlet was observed without a safety cover in Space 13. 10A NCAC 09 .0604(c) 847 Parent's medication authorization did not include required information. The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. 10A NCAC 09 .0803(4)(6-9) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 12/09/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor requirements for adequate and approved space. Technical assistance discussed during today’s visit: • The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. It is imperative that all required records are current and complete at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all medication records and required postings. • Consultation was given to teachers and administration during the Annual Compliance visit conducted on 3/27/2024 regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. This unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. Ms. Gwynn and I discussed potentially using the currently licensed Space 27 for School Age care. Ms. Gwynn stated the school is currently over-enrolled, and finding extra space to utilize, even during time after school, has been challenging. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Gwynn stated she will be considering options for a resolution. An outlet was observed without a safety cover in Space 13; a safety cover was placed in this outlet during the visit. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rule was discussed with Ms. Gwynn during a review of the visit: • 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) - 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. At the completion of the visit, this visit summary was printed and left for Ms. Gwyn to review. I stated I would contact Ms. Gwyn the following day to schedule a time to review this visit via phone. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown-Stewart, Child Care Consultant (336) 408-4849 cara.mckeown-stewart@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0801 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 11/25/2024 Number Present: 53 Completed Date: 11/25/2024 Age: From 3 To 11 Total Minutes: 225 Time In: 01:45 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for a routine unannounced visit. This visit was conducted by Cara McKeown-Stewart, Childcare Consultant with Sharon Leach, Lead Teacher and Diamond Gwyn, Principal. Your program currently operates with a 4-Star license effective 4/08/2022. Restrictions include 1st shift care and meets enhanced ratios. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • CPR / First Aid • Special Training • CBC Qualification • ITS – SIDS • Emergency Medical Care Plan • Administration of Medication • Storage of Hazardous Products • Storage of Medication • General Safety • Discipline • Adequate / Approved Space • Program Records • License Posted • Permit Restrictions The license was observed, and the restrictions monitored. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children playing with toys, engaging in conversations and activities with their teachers, eating snack, and participating in general routines during the visit. One new staff members was reported at this program; one substitute staff member was present with the children in the cafeteria during the visit. The file for this staff member was reviewed. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Recognizing and Responding to Suspicions of Child Abuse and Maltreatment, Special Trainings, and Criminal Background Checks. Storage and administration of medication and medication authorization were monitored. Storage of hazardous items was monitored today. A playground inspection was recorded 10/09/2024. A fire drill was recorded 10/31/2024. A lockdown drill for the facility was recorded 10/02/2024. The most recent fire inspection was on 9/16/2024. I observed a sanitation inspection was last conducted on 4/24/2024 earning a Superior classification. The program does not participate in transportation, off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 209 Children used space that was not approved. An unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. GS 110-91(1)&(4-5) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. .0713(a)(10), (c) & (f)(3); .2818(e) 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. An outlet was observed without a safety cover in Space 13. 10A NCAC 09 .0604(c) 847 Parent's medication authorization did not include required information. The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. 10A NCAC 09 .0803(4)(6-9) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 12/09/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor requirements for adequate and approved space. Technical assistance discussed during today’s visit: • The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. It is imperative that all required records are current and complete at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all medication records and required postings. • Consultation was given to teachers and administration during the Annual Compliance visit conducted on 3/27/2024 regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. This unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. Ms. Gwynn and I discussed potentially using the currently licensed Space 27 for School Age care. Ms. Gwynn stated the school is currently over-enrolled, and finding extra space to utilize, even during time after school, has been challenging. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Gwynn stated she will be considering options for a resolution. An outlet was observed without a safety cover in Space 13; a safety cover was placed in this outlet during the visit. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rule was discussed with Ms. Gwynn during a review of the visit: • 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) - 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. At the completion of the visit, this visit summary was printed and left for Ms. Gwyn to review. I stated I would contact Ms. Gwyn the following day to schedule a time to review this visit via phone. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown-Stewart, Child Care Consultant (336) 408-4849 cara.mckeown-stewart@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0803 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 11/25/2024 Number Present: 53 Completed Date: 11/25/2024 Age: From 3 To 11 Total Minutes: 225 Time In: 01:45 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for a routine unannounced visit. This visit was conducted by Cara McKeown-Stewart, Childcare Consultant with Sharon Leach, Lead Teacher and Diamond Gwyn, Principal. Your program currently operates with a 4-Star license effective 4/08/2022. Restrictions include 1st shift care and meets enhanced ratios. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • CPR / First Aid • Special Training • CBC Qualification • ITS – SIDS • Emergency Medical Care Plan • Administration of Medication • Storage of Hazardous Products • Storage of Medication • General Safety • Discipline • Adequate / Approved Space • Program Records • License Posted • Permit Restrictions The license was observed, and the restrictions monitored. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children playing with toys, engaging in conversations and activities with their teachers, eating snack, and participating in general routines during the visit. One new staff members was reported at this program; one substitute staff member was present with the children in the cafeteria during the visit. The file for this staff member was reviewed. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Recognizing and Responding to Suspicions of Child Abuse and Maltreatment, Special Trainings, and Criminal Background Checks. Storage and administration of medication and medication authorization were monitored. Storage of hazardous items was monitored today. A playground inspection was recorded 10/09/2024. A fire drill was recorded 10/31/2024. A lockdown drill for the facility was recorded 10/02/2024. The most recent fire inspection was on 9/16/2024. I observed a sanitation inspection was last conducted on 4/24/2024 earning a Superior classification. The program does not participate in transportation, off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 209 Children used space that was not approved. An unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. GS 110-91(1)&(4-5) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. .0713(a)(10), (c) & (f)(3); .2818(e) 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. An outlet was observed without a safety cover in Space 13. 10A NCAC 09 .0604(c) 847 Parent's medication authorization did not include required information. The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. 10A NCAC 09 .0803(4)(6-9) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 12/09/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor requirements for adequate and approved space. Technical assistance discussed during today’s visit: • The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. It is imperative that all required records are current and complete at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all medication records and required postings. • Consultation was given to teachers and administration during the Annual Compliance visit conducted on 3/27/2024 regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. This unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. Ms. Gwynn and I discussed potentially using the currently licensed Space 27 for School Age care. Ms. Gwynn stated the school is currently over-enrolled, and finding extra space to utilize, even during time after school, has been challenging. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Gwynn stated she will be considering options for a resolution. An outlet was observed without a safety cover in Space 13; a safety cover was placed in this outlet during the visit. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rule was discussed with Ms. Gwynn during a review of the visit: • 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) - 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. At the completion of the visit, this visit summary was printed and left for Ms. Gwyn to review. I stated I would contact Ms. Gwyn the following day to schedule a time to review this visit via phone. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown-Stewart, Child Care Consultant (336) 408-4849 cara.mckeown-stewart@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 11/25/2024 Number Present: 53 Completed Date: 11/25/2024 Age: From 3 To 11 Total Minutes: 225 Time In: 01:45 PM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Routine Unannounced Announced/Unannounced: Unannounced The purpose of today’s visit was to monitor your program for compliance with applicable childcare requirements for a routine unannounced visit. This visit was conducted by Cara McKeown-Stewart, Childcare Consultant with Sharon Leach, Lead Teacher and Diamond Gwyn, Principal. Your program currently operates with a 4-Star license effective 4/08/2022. Restrictions include 1st shift care and meets enhanced ratios. The program’s compliance history was 90% prior to today’s visit. All programs are required to maintain at least 75% compliance. Today, the following items were monitored: • Supervision • Staff / Child Ratio • CPR / First Aid • Special Training • CBC Qualification • ITS – SIDS • Emergency Medical Care Plan • Administration of Medication • Storage of Hazardous Products • Storage of Medication • General Safety • Discipline • Adequate / Approved Space • Program Records • License Posted • Permit Restrictions The license was observed, and the restrictions monitored. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children playing with toys, engaging in conversations and activities with their teachers, eating snack, and participating in general routines during the visit. One new staff members was reported at this program; one substitute staff member was present with the children in the cafeteria during the visit. The file for this staff member was reviewed. Limited monitoring of staff files was conducted for the purpose of reviewing training regarding CPR/First Aid, EPR, Playground Safety, ITS-SIDS, Recognizing and Responding to Suspicions of Child Abuse and Maltreatment, Special Trainings, and Criminal Background Checks. Storage and administration of medication and medication authorization were monitored. Storage of hazardous items was monitored today. A playground inspection was recorded 10/09/2024. A fire drill was recorded 10/31/2024. A lockdown drill for the facility was recorded 10/02/2024. The most recent fire inspection was on 9/16/2024. I observed a sanitation inspection was last conducted on 4/24/2024 earning a Superior classification. The program does not participate in transportation, off-premise or aquatic activities at this time. The following violations were cited during today’s visit: Violation Number Comment Rule 209 Children used space that was not approved. An unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. GS 110-91(1)&(4-5) 319 Staff/child ratios applicable to a classroom, were not posted in each classroom. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. .0713(a)(10), (c) & (f)(3); .2818(e) 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. An outlet was observed without a safety cover in Space 13. 10A NCAC 09 .0604(c) 847 Parent's medication authorization did not include required information. The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. 10A NCAC 09 .0803(4)(6-9) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 12/09/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. An unannounced follow-up visit will be conducted to monitor requirements for adequate and approved space. Technical assistance discussed during today’s visit: • The medication authorization form for two children enrolled did not include the subject medical condition or allergic reaction. The medication authorization form for one child enrolled did not include the date the authorization was signed by the parent. The staff/child ratio worksheets in Spaces 111 and 38 were posted, but were blank, aside from noting the classroom number. It is imperative that all required records are current and complete at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all medication records and required postings. • Consultation was given to teachers and administration during the Annual Compliance visit conducted on 3/27/2024 regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. This unlicensed space was observed to be in use during today’s visit by one staff member and nine (9) children of School Age. Ms. Gwynn and I discussed potentially using the currently licensed Space 27 for School Age care. Ms. Gwynn stated the school is currently over-enrolled, and finding extra space to utilize, even during time after school, has been challenging. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Gwynn stated she will be considering options for a resolution. An outlet was observed without a safety cover in Space 13; a safety cover was placed in this outlet during the visit. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • The following Child Care Rule was discussed with Ms. Gwynn during a review of the visit: • 10A NCAC 09 .0508 ACTIVITY SCHEDULES AND PLANS (a) - 10A NCAC 09 .0801 APPLICATION FOR ENROLLMENT (b) The process of notifying the Division has changed and is now captured in ABCMS. This change has been in effect since February 2024. Effective immediately, you will need to obtain a Business NCID and complete Provider Portal training in Moodle at https://www.dcdee.moodle.nc.gov/course/view.php?id=119. No action is needed on your part if you have completed the reference training and are currently using the ABCMS Provider Portal to update information regarding new hires or residents. Once the training has been completed and access has been given, you must verify your facility roster to ensure current staff are noted on the roster. This information should be updated in ABCMS in an ongoing basis as staff members are hired and when their employment is terminated. This satisfies the requirement to notify the Division of new child care providers working who were hired or moved into the child care facility within five business days. The compliance of this rule will be monitored during your next visit. Please note, the hard copy of the Change of Information form will no longer be needed or accepted. Should you need assistance please contact the Criminal Background Check Unit at (919) 814-8401 and someone will assist you. North Carolina child care administrators can now view and edit their facility’s staff roster in ABCMS, the DCDEE’s criminal background check system. Provider Access to ABCMS allows administrators to: • See the real-time background check status of staff members. • Run a printable report of the staff roster to assist with compliance visits. • See new background check applicants and add to staff roster. To get started, complete the ABCMS Child Care Provider Portal Training in Moodle—a video tutorial followed by a few questions. At the completion of the visit, this visit summary was printed and left for Ms. Gwyn to review. I stated I would contact Ms. Gwyn the following day to schedule a time to review this visit via phone. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown-Stewart, Child Care Consultant (336) 408-4849 cara.mckeown-stewart@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .1804 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 3/27/2024 Number Present: 36 Completed Date: 3/27/2024 Age: From 6 To 12 Total Minutes: 185 Time In: 02:30 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Diamond Gwyn, Principal, and Sharon Leach, Lead Teacher. Pam Hauser, Licensing Supervisor, was also present for the visit. The initial purpose of today’s visit was to conduct a Routine Unannounced visit. However, upon arrival, Ms. Leach stated the program wanted to request the ERS be completed during their preparation year. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 96 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children completing homework and general routines, engaging in activities and conversations with their teachers, and eating snack during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 9/05/2023. A sanitation inspection was completed 11/21/2023 with a Superior classification. The last fire inspection was conducted 9/26/2023. A copy of this inspection was provided to me during the visit. Program records and required postings were monitored. A fire drill was conducted on 3/25/2024. A shelter in place and lockdown drill were documented on 3/25/2024. An outdoor inspection was documented on 3/05/2024. Staff files and children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted or available for review in Space 2. GS 110-91(12); .0508(a) 1325 Parent’s statement includes the child’s name and date of enrollment and the date the parent signed the statement. The discipline policies for three children enrolled did not include a date of enrollment. .1804(b) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. The certificates for Basic School Age Care were not observed on file for two existing employees. 10A NCAC 09 .2510(f) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. An annual EPR review was not observed on file for two existing employees. .0607(f) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one child enrolled did not contain a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; contact information for the child's health care professional(s); medications to be administered on a scheduled basis; and medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan was also not attached to the child's application. .0801(b) 1898 Staff did not complete the health and safety training within one year of employment. One new employee did not complete Health and Safety training within one year of employment. .1102(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 4/10/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • The Discipline Policy for three children enrolled did not contain an enrollment date and date sigend by parent. Lesson plans were not available for review in Space 2. Two existing employees did not have a Basic School Age Care certificate of training on file for review. Two existing employees did not have an annual Emergency Preparedness and Response review on file. One new employee did not have Health & Safety training completed within one year of hire. The medical action plan for one child enrolled did not include the required criteria. It is imperative that all required records are current and onsite for review at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all program, staff, and children’s files to ensure all records remain complete and current. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • All staff education must be up to date in DCDEE Works. • Consultation was given to teachers regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Leach stated they will move the children to room 11. • The following Child Care Rule was discussed with Ms. Leach during the visit: • 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (c ) • Ms. Hauser discussed with Ms. Gwyn the Staff Orientation form and to ensure the date each item is discussed is accurate. At the completion of the visit, this visit summary was reviewed with Ms. Leach and will be emailed to Ms. Gwyn for review and signature. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .2510 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 3/27/2024 Number Present: 36 Completed Date: 3/27/2024 Age: From 6 To 12 Total Minutes: 185 Time In: 02:30 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Diamond Gwyn, Principal, and Sharon Leach, Lead Teacher. Pam Hauser, Licensing Supervisor, was also present for the visit. The initial purpose of today’s visit was to conduct a Routine Unannounced visit. However, upon arrival, Ms. Leach stated the program wanted to request the ERS be completed during their preparation year. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 96 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children completing homework and general routines, engaging in activities and conversations with their teachers, and eating snack during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 9/05/2023. A sanitation inspection was completed 11/21/2023 with a Superior classification. The last fire inspection was conducted 9/26/2023. A copy of this inspection was provided to me during the visit. Program records and required postings were monitored. A fire drill was conducted on 3/25/2024. A shelter in place and lockdown drill were documented on 3/25/2024. An outdoor inspection was documented on 3/05/2024. Staff files and children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted or available for review in Space 2. GS 110-91(12); .0508(a) 1325 Parent’s statement includes the child’s name and date of enrollment and the date the parent signed the statement. The discipline policies for three children enrolled did not include a date of enrollment. .1804(b) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. The certificates for Basic School Age Care were not observed on file for two existing employees. 10A NCAC 09 .2510(f) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. An annual EPR review was not observed on file for two existing employees. .0607(f) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one child enrolled did not contain a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; contact information for the child's health care professional(s); medications to be administered on a scheduled basis; and medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan was also not attached to the child's application. .0801(b) 1898 Staff did not complete the health and safety training within one year of employment. One new employee did not complete Health and Safety training within one year of employment. .1102(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 4/10/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • The Discipline Policy for three children enrolled did not contain an enrollment date and date sigend by parent. Lesson plans were not available for review in Space 2. Two existing employees did not have a Basic School Age Care certificate of training on file for review. Two existing employees did not have an annual Emergency Preparedness and Response review on file. One new employee did not have Health & Safety training completed within one year of hire. The medical action plan for one child enrolled did not include the required criteria. It is imperative that all required records are current and onsite for review at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all program, staff, and children’s files to ensure all records remain complete and current. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • All staff education must be up to date in DCDEE Works. • Consultation was given to teachers regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Leach stated they will move the children to room 11. • The following Child Care Rule was discussed with Ms. Leach during the visit: • 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (c ) • Ms. Hauser discussed with Ms. Gwyn the Staff Orientation form and to ensure the date each item is discussed is accurate. At the completion of the visit, this visit summary was reviewed with Ms. Leach and will be emailed to Ms. Gwyn for review and signature. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

GS 110-91 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 3/27/2024 Number Present: 36 Completed Date: 3/27/2024 Age: From 6 To 12 Total Minutes: 185 Time In: 02:30 PM Time Out: 05:35 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp w/Rated Lic Assess Announced/Unannounced: Unannounced An unannounced annual compliance visit and rated license assessment was conducted at this childcare center to monitor compliance with applicable childcare requirements. This visit was conducted by Cara McKeown-Stewart, childcare consultant with Diamond Gwyn, Principal, and Sharon Leach, Lead Teacher. Pam Hauser, Licensing Supervisor, was also present for the visit. The initial purpose of today’s visit was to conduct a Routine Unannounced visit. However, upon arrival, Ms. Leach stated the program wanted to request the ERS be completed during their preparation year. Your program currently operates with a 4- Star license. Restrictions include first shift care and meets enhanced ratios. The license was observed, and the restrictions were found in compliance. The program’s compliance history was 96 % prior to today’s visit. All programs are required to maintain at least 75% compliance. A walk-through of the facility was completed today. Indoor and outdoor areas were observed. Staff/child ratio and space capacity were monitored as indicated on the attached worksheet. Supervision was adequate during the visit. I observed staff/child interactions today. I observed children completing homework and general routines, engaging in activities and conversations with their teachers, and eating snack during the visit. I observed materials and activities that were available to the children in the classrooms. The last annual compliance visit was conducted on 9/05/2023. A sanitation inspection was completed 11/21/2023 with a Superior classification. The last fire inspection was conducted 9/26/2023. A copy of this inspection was provided to me during the visit. Program records and required postings were monitored. A fire drill was conducted on 3/25/2024. A shelter in place and lockdown drill were documented on 3/25/2024. An outdoor inspection was documented on 3/05/2024. Staff files and children’s records were monitored per DCDEE procedures. Nutrition requirements were monitored per DCDEE procedures. Storage of hazardous items was monitored today. Storage and administration of medication were monitored. Medication authorization was monitored. The program does not provide transportation. The following violations were cited during today’s visit: Violation Number Comment Rule 428 A current activity plan was not posted for each group of children for reference. An activity plan was not posted or available for review in Space 2. GS 110-91(12); .0508(a) 1325 Parent’s statement includes the child’s name and date of enrollment and the date the parent signed the statement. The discipline policies for three children enrolled did not include a date of enrollment. .1804(b) 1441 An individual responsible for both administering the program and planning and ensuring the implementation of the daily activities did not meet requirements for an administrator and/or complete BSAC training. The certificates for Basic School Age Care were not observed on file for two existing employees. 10A NCAC 09 .2510(f) 1825 All staff did not review the center's EPR Plan during orientation and/or on an annual basis with the trained staff. Documentation of the review was not maintained on file. An annual EPR review was not observed on file for two existing employees. .0607(f) 1835 The medical action plan was not updated on an annual basis or when changes to the plan were made by the child's parent or health care professional. The medical action plan for one child enrolled did not contain a list of the child's diagnosis or diagnoses including dietary, environmental, and activity considerations that are applicable; contact information for the child's health care professional(s); medications to be administered on a scheduled basis; and medications to be administered on an emergency basis with symptoms, and instructions. The medical action plan was also not attached to the child's application. .0801(b) 1898 Staff did not complete the health and safety training within one year of employment. One new employee did not complete Health and Safety training within one year of employment. .1102(a) Child Care programs are expected to achieve and maintain compliance at all times and are required by NC GS 10-90(4) (d) to achieve and maintain an eighteen-month compliance history score of at least seventy-five percent. Any violation(s) documented may impact the compliance history score. You must correct the violations cited during today's visit immediately and send me documentation verifying compliance on or before 4/10/2024. The following information must be included in your signed and dated compliance letter: • the name of your center • facility ID number • date • title of the person who signs the letter • each violation number(s) • describes accurately and in detail how and when you corrected each violation You may email the letter to cara.mckeown-stewart@dhhs.nc.gov or mail two copies of the letter to: Cara McKeown 353 Jonestown Road, Unit #146 Winston Salem, NC 27104 If you state in your letter that corrections or changes have been made when they have not, it will be considered falsification of information and could lead to administrative action taken by the DCDEE. Repeated violations, continued non-compliance, or failure to submit the compliance letter prior to the date given in this visit summary can also lead to administrative action taken by the DCDEE. Additional monitoring visits may be conducted during the year to monitor compliance with applicable childcare requirements. Technical assistance discussed during today’s visit: • The Discipline Policy for three children enrolled did not contain an enrollment date and date sigend by parent. Lesson plans were not available for review in Space 2. Two existing employees did not have a Basic School Age Care certificate of training on file for review. Two existing employees did not have an annual Emergency Preparedness and Response review on file. One new employee did not have Health & Safety training completed within one year of hire. The medical action plan for one child enrolled did not include the required criteria. It is imperative that all required records are current and onsite for review at all times to ensure the health, safety, and quality of care of children enrolled. I recommended Ms. Gwyn and staff create a routine schedule for monitoring all program, staff, and children’s files to ensure all records remain complete and current. Additional Information/Consultation: • You must notify your consultant 30 days prior to changing the ownership status of your facility. • All staff education must be up to date in DCDEE Works. • Consultation was given to teachers regarding the utilization of the cafeteria for School Age care. This cafeteria was approved for snacks only by a previous consultant on 10/17/11. If you wish to continue to use this space, the space will need to be measured, and all required postings and School Age materials will need to be posted and/or accessible in this space. Please state in your compliance letter if you will continue to use this space. Ms. Leach stated they will move the children to room 11. • The following Child Care Rule was discussed with Ms. Leach during the visit: • 10A NCAC 09 .1804 DISCIPLINE POLICY FOR CHILD CARE CENTERS (c ) • Ms. Hauser discussed with Ms. Gwyn the Staff Orientation form and to ensure the date each item is discussed is accurate. At the completion of the visit, this visit summary was reviewed with Ms. Leach and will be emailed to Ms. Gwyn for review and signature. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0601 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 9/5/2023 Number Present: 30 Completed Date: 9/5/2023 Age: From 6 To 12 Total Minutes: 885 Time In: 02:45 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this child care center to monitor compliance with applicable child care requirements. This visit was conducted by Cara McKeown-Stewart, Child Care Consultant with Thresa Cole, Program Coordinator. Currently this center operates with a Four (4) star license issued April 8, 2022, earned with seven (7) points in staff education, three (3) points in program standards and one (1) quality point. Restrictions include first shift care and meets enhanced ratios. The last annual compliance visit was completed on September 13, 2022. The sanitation inspection was completed November 29, 2022, with a "Superior" classification with five demerits. The fire inspection was completed on September 27, 2022. A copy of the inspection was provided during the visit. Winston Salem Forsyth County Schools operates this program. Two classrooms were observed during the visit. Staff/child ratio was observed and in compliance as indicated on the attached enrollment worksheet. Children were adequately supervised. Indoor and outdoor areas were observed during today's visit. A restriction will be placed on the license following the visit stating, “School Age equipment cannot be used by preschool children”. Ms. Diamond Cotton, Principal, stated she would email me the manufacturer’s instructions for the new playground equipment designated for use by children of preschool age. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Storage of hazardous materials was monitored. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. Ms. Berry placed these wipes into locked storage during the visit. Ms. Cole stated no children enrolled take medication during operating hours. Thirty (30) children (in two classrooms) were present during today’s visit. The children were observed completing homework, eating an afternoon snack, and playing with different developmentally appropriate games or toys. Fire drill reports and playground inspections were monitored during today's visit. The last fire drill was conducted on 8/30/2023. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. The last lockdown and shelter-in-place drill was documented on 3/08/2023. An outdoor inspection was documented on 9/01/2023. The children use the Pre-K playground, which also contains a stationary structure approved for use for children five to twelve years of age, to play outdoors. Staff and children’s files were reviewed today following the Division of Child Development and Early Education procedures. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. Ms. Cole stated the program does not provide routine transportation. This facility does participate in off premise or aquatic activities. The following violations were observed during today's visit. Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. G.S. 110-91(9); .0304(g); .2318 807 A safe indoor and outdoor environment was not provided for the children. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. 10A NCAC 09 .0601(a) Technical assistance and other topics discussed during today's visit: • Please add a copy of the site’s Critical Incident Plan (for Winston Salem Forsyth County Schools) to each classroom file containing lockdown procedures, tornado procedures, emergency protocol, etc. • Please review your Staff and Training worksheet and staff files in detail to ensure all recorded information is accurate and up to date. • Please review all children’s files to ensure that all required documentation is present in each file. • Please review all staff members’ files to ensure all required information is on file for review. • Please ensure that the most updated education information is entered into DCDEE Works for all staff members. • Please monitor the playground fencing for developing rust. • Please monitor the playground for trash and/or debris prior to the children’s use. • Please ensure snack menus are posted in each classroom no later than the beginning of the school day on the 1st of every month and that all snack substitutions are recorded on the menu prior to meal service. • Please ensure Emergency Drill Logs have each section fully completed after each fire drill and/or lockdown/shelter-in-place drill. • Please ensure all staff/child ratio worksheets for extended day classrooms are posted. - Please ensure a First Aid kit is accessible in all Extended Day classrooms. • The following Child Care Rules and Child Care Sanitation Rules were thoroughly discussed and reviewed with Ms. Cotton, Principal during the visit: 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) Grass, fruit and vegetable gardens, vines on fences, and other vegetation shall be maintained to prevent the harboring and breeding of pests. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. 10A NCAC 09 .0510 ACTIVITY AREAS (d) When preschool children three years old and older are in care the following shall apply: (2) when screen time is provided on any electronic media device with a visual display, it shall be: (A) offered to stimulate a developmental domain in accordance with the North Carolina Foundations for Early Learning and Development as referenced in Rule .0508 of this Section; (B) limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and (C) documented on a cumulative log or the activity plan that shall be available for review by the Division. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0510 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 9/5/2023 Number Present: 30 Completed Date: 9/5/2023 Age: From 6 To 12 Total Minutes: 885 Time In: 02:45 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this child care center to monitor compliance with applicable child care requirements. This visit was conducted by Cara McKeown-Stewart, Child Care Consultant with Thresa Cole, Program Coordinator. Currently this center operates with a Four (4) star license issued April 8, 2022, earned with seven (7) points in staff education, three (3) points in program standards and one (1) quality point. Restrictions include first shift care and meets enhanced ratios. The last annual compliance visit was completed on September 13, 2022. The sanitation inspection was completed November 29, 2022, with a "Superior" classification with five demerits. The fire inspection was completed on September 27, 2022. A copy of the inspection was provided during the visit. Winston Salem Forsyth County Schools operates this program. Two classrooms were observed during the visit. Staff/child ratio was observed and in compliance as indicated on the attached enrollment worksheet. Children were adequately supervised. Indoor and outdoor areas were observed during today's visit. A restriction will be placed on the license following the visit stating, “School Age equipment cannot be used by preschool children”. Ms. Diamond Cotton, Principal, stated she would email me the manufacturer’s instructions for the new playground equipment designated for use by children of preschool age. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Storage of hazardous materials was monitored. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. Ms. Berry placed these wipes into locked storage during the visit. Ms. Cole stated no children enrolled take medication during operating hours. Thirty (30) children (in two classrooms) were present during today’s visit. The children were observed completing homework, eating an afternoon snack, and playing with different developmentally appropriate games or toys. Fire drill reports and playground inspections were monitored during today's visit. The last fire drill was conducted on 8/30/2023. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. The last lockdown and shelter-in-place drill was documented on 3/08/2023. An outdoor inspection was documented on 9/01/2023. The children use the Pre-K playground, which also contains a stationary structure approved for use for children five to twelve years of age, to play outdoors. Staff and children’s files were reviewed today following the Division of Child Development and Early Education procedures. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. Ms. Cole stated the program does not provide routine transportation. This facility does participate in off premise or aquatic activities. The following violations were observed during today's visit. Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. G.S. 110-91(9); .0304(g); .2318 807 A safe indoor and outdoor environment was not provided for the children. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. 10A NCAC 09 .0601(a) Technical assistance and other topics discussed during today's visit: • Please add a copy of the site’s Critical Incident Plan (for Winston Salem Forsyth County Schools) to each classroom file containing lockdown procedures, tornado procedures, emergency protocol, etc. • Please review your Staff and Training worksheet and staff files in detail to ensure all recorded information is accurate and up to date. • Please review all children’s files to ensure that all required documentation is present in each file. • Please review all staff members’ files to ensure all required information is on file for review. • Please ensure that the most updated education information is entered into DCDEE Works for all staff members. • Please monitor the playground fencing for developing rust. • Please monitor the playground for trash and/or debris prior to the children’s use. • Please ensure snack menus are posted in each classroom no later than the beginning of the school day on the 1st of every month and that all snack substitutions are recorded on the menu prior to meal service. • Please ensure Emergency Drill Logs have each section fully completed after each fire drill and/or lockdown/shelter-in-place drill. • Please ensure all staff/child ratio worksheets for extended day classrooms are posted. - Please ensure a First Aid kit is accessible in all Extended Day classrooms. • The following Child Care Rules and Child Care Sanitation Rules were thoroughly discussed and reviewed with Ms. Cotton, Principal during the visit: 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) Grass, fruit and vegetable gardens, vines on fences, and other vegetation shall be maintained to prevent the harboring and breeding of pests. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. 10A NCAC 09 .0510 ACTIVITY AREAS (d) When preschool children three years old and older are in care the following shall apply: (2) when screen time is provided on any electronic media device with a visual display, it shall be: (A) offered to stimulate a developmental domain in accordance with the North Carolina Foundations for Early Learning and Development as referenced in Rule .0508 of this Section; (B) limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and (C) documented on a cumulative log or the activity plan that shall be available for review by the Division. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

10A NCAC 09 .0605 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 9/5/2023 Number Present: 30 Completed Date: 9/5/2023 Age: From 6 To 12 Total Minutes: 885 Time In: 02:45 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this child care center to monitor compliance with applicable child care requirements. This visit was conducted by Cara McKeown-Stewart, Child Care Consultant with Thresa Cole, Program Coordinator. Currently this center operates with a Four (4) star license issued April 8, 2022, earned with seven (7) points in staff education, three (3) points in program standards and one (1) quality point. Restrictions include first shift care and meets enhanced ratios. The last annual compliance visit was completed on September 13, 2022. The sanitation inspection was completed November 29, 2022, with a "Superior" classification with five demerits. The fire inspection was completed on September 27, 2022. A copy of the inspection was provided during the visit. Winston Salem Forsyth County Schools operates this program. Two classrooms were observed during the visit. Staff/child ratio was observed and in compliance as indicated on the attached enrollment worksheet. Children were adequately supervised. Indoor and outdoor areas were observed during today's visit. A restriction will be placed on the license following the visit stating, “School Age equipment cannot be used by preschool children”. Ms. Diamond Cotton, Principal, stated she would email me the manufacturer’s instructions for the new playground equipment designated for use by children of preschool age. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Storage of hazardous materials was monitored. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. Ms. Berry placed these wipes into locked storage during the visit. Ms. Cole stated no children enrolled take medication during operating hours. Thirty (30) children (in two classrooms) were present during today’s visit. The children were observed completing homework, eating an afternoon snack, and playing with different developmentally appropriate games or toys. Fire drill reports and playground inspections were monitored during today's visit. The last fire drill was conducted on 8/30/2023. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. The last lockdown and shelter-in-place drill was documented on 3/08/2023. An outdoor inspection was documented on 9/01/2023. The children use the Pre-K playground, which also contains a stationary structure approved for use for children five to twelve years of age, to play outdoors. Staff and children’s files were reviewed today following the Division of Child Development and Early Education procedures. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. Ms. Cole stated the program does not provide routine transportation. This facility does participate in off premise or aquatic activities. The following violations were observed during today's visit. Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. G.S. 110-91(9); .0304(g); .2318 807 A safe indoor and outdoor environment was not provided for the children. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. 10A NCAC 09 .0601(a) Technical assistance and other topics discussed during today's visit: • Please add a copy of the site’s Critical Incident Plan (for Winston Salem Forsyth County Schools) to each classroom file containing lockdown procedures, tornado procedures, emergency protocol, etc. • Please review your Staff and Training worksheet and staff files in detail to ensure all recorded information is accurate and up to date. • Please review all children’s files to ensure that all required documentation is present in each file. • Please review all staff members’ files to ensure all required information is on file for review. • Please ensure that the most updated education information is entered into DCDEE Works for all staff members. • Please monitor the playground fencing for developing rust. • Please monitor the playground for trash and/or debris prior to the children’s use. • Please ensure snack menus are posted in each classroom no later than the beginning of the school day on the 1st of every month and that all snack substitutions are recorded on the menu prior to meal service. • Please ensure Emergency Drill Logs have each section fully completed after each fire drill and/or lockdown/shelter-in-place drill. • Please ensure all staff/child ratio worksheets for extended day classrooms are posted. - Please ensure a First Aid kit is accessible in all Extended Day classrooms. • The following Child Care Rules and Child Care Sanitation Rules were thoroughly discussed and reviewed with Ms. Cotton, Principal during the visit: 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) Grass, fruit and vegetable gardens, vines on fences, and other vegetation shall be maintained to prevent the harboring and breeding of pests. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. 10A NCAC 09 .0510 ACTIVITY AREAS (d) When preschool children three years old and older are in care the following shall apply: (2) when screen time is provided on any electronic media device with a visual display, it shall be: (A) offered to stimulate a developmental domain in accordance with the North Carolina Foundations for Early Learning and Development as referenced in Rule .0508 of this Section; (B) limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and (C) documented on a cumulative log or the activity plan that shall be available for review by the Division. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times

G.S. 110-91 · Violation

Name of Operation: KIMBERLEY PARK EXTENDED DAY PROGRAM Facility ID: 34001180 Consultant: CARA MCKEOWN-STEWART Operation Type: Center Case Number: Visit Date: 9/5/2023 Number Present: 30 Completed Date: 9/5/2023 Age: From 6 To 12 Total Minutes: 885 Time In: 02:45 AM Time Out: 05:30 PM Time In: Time Out: List to Use: Center Type Of Visit: Annual Comp Full Announced/Unannounced: Unannounced An unannounced annual compliance visit was conducted at this child care center to monitor compliance with applicable child care requirements. This visit was conducted by Cara McKeown-Stewart, Child Care Consultant with Thresa Cole, Program Coordinator. Currently this center operates with a Four (4) star license issued April 8, 2022, earned with seven (7) points in staff education, three (3) points in program standards and one (1) quality point. Restrictions include first shift care and meets enhanced ratios. The last annual compliance visit was completed on September 13, 2022. The sanitation inspection was completed November 29, 2022, with a "Superior" classification with five demerits. The fire inspection was completed on September 27, 2022. A copy of the inspection was provided during the visit. Winston Salem Forsyth County Schools operates this program. Two classrooms were observed during the visit. Staff/child ratio was observed and in compliance as indicated on the attached enrollment worksheet. Children were adequately supervised. Indoor and outdoor areas were observed during today's visit. A restriction will be placed on the license following the visit stating, “School Age equipment cannot be used by preschool children”. Ms. Diamond Cotton, Principal, stated she would email me the manufacturer’s instructions for the new playground equipment designated for use by children of preschool age. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Storage of hazardous materials was monitored. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. Ms. Berry placed these wipes into locked storage during the visit. Ms. Cole stated no children enrolled take medication during operating hours. Thirty (30) children (in two classrooms) were present during today’s visit. The children were observed completing homework, eating an afternoon snack, and playing with different developmentally appropriate games or toys. Fire drill reports and playground inspections were monitored during today's visit. The last fire drill was conducted on 8/30/2023. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. The last lockdown and shelter-in-place drill was documented on 3/08/2023. An outdoor inspection was documented on 9/01/2023. The children use the Pre-K playground, which also contains a stationary structure approved for use for children five to twelve years of age, to play outdoors. Staff and children’s files were reviewed today following the Division of Child Development and Early Education procedures. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. Ms. Cole stated the program does not provide routine transportation. This facility does participate in off premise or aquatic activities. The following violations were observed during today's visit. Violation Number Comment Rule 124 The center did not maintain records as required in rule, and/or were not made available to the Division for review. An updated Professional Development Plan, Health Questionnaire, Emergency Contact Information, Emergency Preparedness and Response Plan Review, and Emergency Medical Care Plan Review were not on file for review for one staff member. A record of ongoing training, Health and Safety trainings and certificate of Recognizing and Responding to Suspicions of Child Abuse and Maltreatment were also not on file for review for one staff member. Documentation of immunization records was not on file for five children enrolled. A health assessment was not on file for two children enrolled. A signed receipt of Discipline Policy was not on file for five children enrolled. The file for one child enrolled was not available for review. The Public School Offsite Records Verification forms for Staff Records were not available for review. A fire drill for May or June, 2023 were not recorded. A lockdown and shelter-in-place drill was not documented for January, 2023. G.S. 110-91(9); .0304(g); .2318 807 A safe indoor and outdoor environment was not provided for the children. A cracked, plastic clear bin was observed on the playground on top of the sand and water table and sharp to the touch. A shed located within the fenced area at the back, right side of the playground (facing away from the building), was observed to have plastic siding at the bottom which was observed to be cracked and sharp to the touch in greater than three places. Additionally, a wooden board which became detached from the shed exposed a protruding screw, observed to be sharp to the touch. Clorox wipes were observed in Space 38 greater than five feet from the ground, but in unlocked storage. 10A NCAC 09 .0601(a) Technical assistance and other topics discussed during today's visit: • Please add a copy of the site’s Critical Incident Plan (for Winston Salem Forsyth County Schools) to each classroom file containing lockdown procedures, tornado procedures, emergency protocol, etc. • Please review your Staff and Training worksheet and staff files in detail to ensure all recorded information is accurate and up to date. • Please review all children’s files to ensure that all required documentation is present in each file. • Please review all staff members’ files to ensure all required information is on file for review. • Please ensure that the most updated education information is entered into DCDEE Works for all staff members. • Please monitor the playground fencing for developing rust. • Please monitor the playground for trash and/or debris prior to the children’s use. • Please ensure snack menus are posted in each classroom no later than the beginning of the school day on the 1st of every month and that all snack substitutions are recorded on the menu prior to meal service. • Please ensure Emergency Drill Logs have each section fully completed after each fire drill and/or lockdown/shelter-in-place drill. • Please ensure all staff/child ratio worksheets for extended day classrooms are posted. - Please ensure a First Aid kit is accessible in all Extended Day classrooms. • The following Child Care Rules and Child Care Sanitation Rules were thoroughly discussed and reviewed with Ms. Cotton, Principal during the visit: 15A NCAC 18A .2831 ANIMAL AND VERMIN CONTROL (i) Grass, fruit and vegetable gardens, vines on fences, and other vegetation shall be maintained to prevent the harboring and breeding of pests. 10A NCAC 09 .0605 OUTDOOR LEARNING ENVIRONMENT IN CHILD CARE CENTERS (q) Following completion of playground safety training as required by Rule .1102(e) of this Chapter, a monthly playground inspection shall be conducted by an individual trained in playground safety requirements. A trained administrator or staff person shall make a record of each inspection using a playground inspection checklist provided by the Division. The checklist shall be signed by the person who conducts the inspection and shall be maintained for 12 months in the center's files for review by a representative of the Division. The playground inspection checklist may be found online at https://ncchildcare.ncdhhs.gov/providers/credent.asp. The playground inspection includes a checklist of items related to safety, surfacing, and equipment quality. 10A NCAC 09 .0510 ACTIVITY AREAS (d) When preschool children three years old and older are in care the following shall apply: (2) when screen time is provided on any electronic media device with a visual display, it shall be: (A) offered to stimulate a developmental domain in accordance with the North Carolina Foundations for Early Learning and Development as referenced in Rule .0508 of this Section; (B) limited to 30 minutes per day and no more than a total of two and a half hours per week, per child; and (C) documented on a cumulative log or the activity plan that shall be available for review by the Division. At the completion of the visit, this visit summary was reviewed with and provided to you. Thank you for your time and assistance during the visit. If you have any questions about the visit, please contact me or my supervisor using the information below. Cara McKeown, Child Care Consultant (336) 408-4849 cara.mckeown@dhhs.nc.gov Pamela Hauser, Supervisor pamela.hauser@dhhs.nc.gov For the latest information on childcare rules and regulations, please visit the Division of Child Development and Early Education's website at https://ncchildcare.ncdhhs.gov/ If the operator fails to correct any documented violations within the established time period, the Division of Child Development and Early Education may deny, suspend, terminate, or revoke any permit to operate (10A NCAC 09 .2000). All information in this report has been reviewed with me today.I understand that it is my responsibility to maintaincompliance with applicable NC Child Care Requirements at all times